Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.07 / $104.63 / $189.70	Facility	26	$55.07	$104.63	$189.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $163.72 / $275.00 / $1,085.00	Professional		$163.72	$275.00	$1,085.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.80 / $58.21 / $235.94	Professional	26	$50.80	$58.21	$235.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.53 / $180.17 / $362.33	Professional	TC	$111.53	$180.17	$362.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $185.64 / $191.21 / $196.78	Facility	26	$185.64	$191.21	$196.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $246.18 / $437.67 / $734.71	Professional		$246.18	$437.67	$734.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.21 / $126.00 / $171.86	Professional	26	$58.21	$126.00	$171.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $188.82 / $317.83 / $582.36	Professional	TC	$188.82	$317.83	$582.36
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $148.81 / $275.58 / $899.04	Professional		$148.81	$275.58	$899.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.20 / $82.92 / $205.06	Professional	26	$51.20	$82.92	$205.06
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.61 / $183.35 / $728.13	Professional	TC	$97.61	$183.35	$728.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $400.16 / $518.00 / $518.00	Facility	26	$400.16	$518.00	$518.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $201.99 / $361.50 / $1,890.30	Professional		$201.99	$361.50	$1,890.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $62.94 / $91.58 / $450.76	Professional	26	$62.94	$91.58	$450.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $134.83 / $229.41 / $1,576.92	Professional	TC	$134.83	$229.41	$1,576.92
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $191.21 / $196.78 / $307.14	Facility	26	$191.21	$196.78	$307.14
Midlands Facility/Professional Professional Modifier Low / Median / High Price $321.11 / $446.99 / $606.00	Professional		$321.11	$446.99	$606.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $55.05 / $157.41 / $278.25	Professional		$55.05	$157.41	$278.25
United Facility/Professional Professional Modifier Low / Median / High Price $197.68 / $239.12 / $416.59	Professional		$197.68	$239.12	$416.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.05 / $77.03 / $137.99	Professional	26	$61.05	$77.03	$137.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.87 / $162.38 / $298.50	Professional	TC	$128.87	$162.38	$298.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $257.54 / $326.00 / $383.50	Professional		$257.54	$326.00	$383.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $83.11 / $105.20 / $123.80	Professional	26	$83.11	$105.20	$123.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $174.43 / $220.80 / $259.70	Professional	TC	$174.43	$220.80	$259.70