Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.78 / $182.20 / $336.82	Facility	26	$90.78	$182.20	$336.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $233.82 / $374.02 / $522.50	Professional		$233.82	$374.02	$522.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.65 / $86.13 / $145.65	Professional	26	$57.65	$86.13	$145.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $174.74 / $283.68 / $368.50	Professional	TC	$174.74	$283.68	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.92 / $183.26 / $188.60	Facility	26	$177.92	$183.26	$188.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.90 / $573.13 / $1,275.78	Professional		$354.90	$573.13	$1,275.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.65 / $128.77 / $176.25	Professional	26	$59.65	$128.77	$176.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.80 / $473.32 / $1,129.11	Professional	TC	$287.80	$473.32	$1,129.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $201.46 / $346.91 / $1,422.87	Professional		$201.46	$346.91	$1,422.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.49 / $86.21 / $346.75	Professional	26	$52.49	$86.21	$346.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.97 / $262.04 / $1,160.11	Professional	TC	$148.97	$262.04	$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 $262.50 / $493.15 / $2,955.62	Professional		$262.50	$493.15	$2,955.62
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.63 / $76.34 / $596.05	Professional	26	$58.63	$76.34	$596.05
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $198.01 / $347.42 / $2,626.86	Professional	TC	$198.01	$347.42	$2,626.86
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $183.26 / $188.60 / $315.00	Facility	26	$183.26	$188.60	$315.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $441.87 / $615.84 / $956.00	Professional		$441.87	$615.84	$956.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.39 / $212.33 / $376.99	Professional		$56.39	$212.33	$376.99
United Facility/Professional Professional Modifier Low / Median / High Price $243.44 / $312.25 / $654.74	Professional		$243.44	$312.25	$654.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.63 / $73.62 / $160.65	Professional	26	$58.63	$73.62	$160.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $180.01 / $238.63 / $535.08	Professional	TC	$180.01	$238.63	$535.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $407.56 / $515.90 / $606.90	Professional		$407.56	$515.90	$606.90
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 $308.73 / $390.80 / $459.80	Professional	TC	$308.73	$390.80	$459.80