Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.25 / $114.17 / $294.50	Facility	26	$52.25	$114.17	$294.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $222.03 / $425.00 / $598.50	Professional		$222.03	$425.00	$598.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.97 / $126.00 / $189.00	Professional	26	$57.97	$126.00	$189.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.90 / $299.00 / $382.28	Professional	TC	$162.90	$299.00	$382.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $179.90 / $185.30 / $190.69	Facility	26	$179.90	$185.30	$190.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $360.81 / $601.36 / $1,297.13	Professional		$360.81	$601.36	$1,297.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.65 / $128.77 / $179.09	Professional	26	$59.65	$128.77	$179.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $280.00 / $481.90 / $1,150.48	Professional	TC	$280.00	$481.90	$1,150.48
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $190.96 / $328.55 / $1,322.06	Professional		$190.96	$328.55	$1,322.06
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.49 / $86.21 / $222.22	Professional	26	$52.49	$86.21	$222.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.47 / $243.68 / $1,160.11	Professional	TC	$138.47	$243.68	$1,160.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $409.92 / $530.79 / $530.79	Facility	26	$409.92	$530.79	$530.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $251.34 / $482.04 / $2,968.23	Professional		$251.34	$482.04	$2,968.23
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.63 / $76.34 / $505.24	Professional	26	$58.63	$76.34	$505.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $186.85 / $327.83 / $2,638.88	Professional	TC	$186.85	$327.83	$2,638.88
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $185.30 / $190.69 / $315.00	Facility	26	$185.30	$190.69	$315.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $419.33 / $619.57 / $906.66	Professional		$419.33	$619.57	$906.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.39 / $201.65 / $357.39	Professional		$56.39	$201.65	$357.39
United Facility/Professional Professional Modifier Low / Median / High Price $228.49 / $297.54 / $626.05	Professional		$228.49	$297.54	$626.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.63 / $73.62 / $149.69	Professional	26	$58.63	$73.62	$149.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.86 / $221.19 / $538.15	Professional	TC	$169.86	$221.19	$538.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $385.76 / $488.30 / $574.50	Professional		$385.76	$488.30	$574.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $98.83 / $125.10 / $147.10	Professional	26	$98.83	$125.10	$147.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $287.01 / $363.30 / $427.40	Professional	TC	$287.01	$363.30	$427.40