Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.78 / $182.64 / $337.92	Facility	26	$90.78	$182.64	$337.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $222.36 / $425.00 / $700.00	Professional		$222.36	$425.00	$700.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.32 / $90.84 / $265.29	Professional	26	$57.32	$90.84	$265.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $163.22 / $299.00 / $368.50	Professional	TC	$163.22	$299.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $179.63 / $185.02 / $190.41	Facility	26	$179.63	$185.02	$190.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $362.21 / $573.13 / $1,294.29	Professional		$362.21	$573.13	$1,294.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.97 / $129.54 / $177.26	Professional	26	$59.97	$129.54	$177.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $280.00 / $448.43 / $1,147.63	Professional	TC	$280.00	$448.43	$1,147.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $191.53 / $329.54 / $1,321.08	Professional		$191.53	$329.54	$1,321.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.77 / $86.71 / $300.85	Professional	26	$52.77	$86.71	$300.85
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.75 / $244.17 / $1,138.21	Professional	TC	$138.75	$244.17	$1,138.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $412.32 / $530.79 / $530.79	Facility	26	$412.32	$530.79	$530.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $252.42 / $470.73 / $2,961.02	Professional		$252.42	$470.73	$2,961.02
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.96 / $76.78 / $505.24	Professional	26	$58.96	$76.78	$505.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $187.56 / $329.08 / $2,631.72	Professional	TC	$187.56	$329.08	$2,631.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $185.02 / $190.41 / $315.00	Facility	26	$185.02	$190.41	$315.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $419.95 / $585.15 / $906.66	Professional		$419.95	$585.15	$906.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.52 / $201.65 / $358.45	Professional		$56.52	$201.65	$358.45
United Facility/Professional Professional Modifier Low / Median / High Price $229.47 / $298.82 / $662.24	Professional		$229.47	$298.82	$662.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.96 / $70.75 / $149.69	Professional	26	$58.96	$70.75	$149.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $174.05 / $226.07 / $513.92	Professional	TC	$174.05	$226.07	$513.92
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $386.94 / $489.80 / $576.29	Professional		$386.94	$489.80	$576.29
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $99.38 / $125.80 / $148.00	Professional	26	$99.38	$125.80	$148.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $287.56 / $364.00 / $428.30	Professional	TC	$287.56	$364.00	$428.30