Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.18 / $78.55 / $96.91	Facility	26	$47.18	$78.55	$96.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.41 / $160.31 / $364.32	Professional		$134.41	$160.31	$364.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.28 / $55.00 / $167.25	Professional	26	$48.28	$55.00	$167.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.87 / $100.51 / $220.00	Professional	TC	$86.87	$100.51	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.00 / $59.00 / $59.00	Facility	26	$59.00	$59.00	$59.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.79 / $327.35 / $409.18	Professional		$141.79	$327.35	$409.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.11 / $116.36 / $145.44	Professional	26	$51.11	$116.36	$145.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.91 / $210.99 / $263.74	Professional	TC	$92.91	$210.99	$263.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $138.33 / $191.61 / $734.93	Professional		$138.33	$191.61	$734.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.09 / $73.01 / $160.27	Professional	26	$52.09	$73.01	$160.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.29 / $118.61 / $427.35	Professional	TC	$87.29	$118.61	$427.35
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $371.04 / $479.84 / $479.84	Facility	26	$371.04	$479.84	$479.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $150.16 / $221.30 / $772.68	Professional		$150.16	$221.30	$772.68
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $67.95 / $323.73	Professional	26	$52.18	$67.95	$323.73
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $94.40 / $122.11 / $591.79	Professional	TC	$94.40	$122.11	$591.79
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $59.00 / $59.00 / $284.22	Facility	26	$59.00	$59.00	$284.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $264.38 / $298.17 / $474.36	Professional		$264.38	$298.17	$474.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.92 / $125.75 / $230.64	Professional		$50.92	$125.75	$230.64
United Facility/Professional Professional Modifier Low / Median / High Price $148.63 / $175.14 / $330.83	Professional		$148.63	$175.14	$330.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $65.40 / $118.29	Professional	26	$52.18	$65.40	$118.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.72 / $122.11 / $213.80	Professional	TC	$94.72	$122.11	$213.80
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $212.43 / $268.89 / $316.30	Professional		$212.43	$268.89	$316.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $77.03 / $97.50 / $114.80	Professional	26	$77.03	$97.50	$114.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $135.33 / $171.30 / $201.60	Professional	TC	$135.33	$171.30	$201.60