Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.95 / $89.20 / $163.03	Facility	26	$46.95	$89.20	$163.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.01 / $232.80 / $990.37	Professional		$130.01	$232.80	$990.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.56 / $55.00 / $251.00	Professional	26	$44.56	$55.00	$251.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.05 / $165.54 / $291.63	Professional	TC	$83.05	$165.54	$291.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $158.99 / $163.76 / $168.53	Facility	26	$158.99	$163.76	$168.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.23 / $321.30 / $600.87	Professional		$194.23	$321.30	$600.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $109.15 / $159.57	Professional	26	$49.68	$109.15	$159.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.05 / $209.26 / $469.87	Professional	TC	$127.05	$209.26	$469.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $116.37 / $215.43 / $768.50	Professional		$116.37	$215.43	$768.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.74 / $77.31 / $190.70	Professional	26	$43.74	$77.31	$190.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.63 / $136.58 / $596.24	Professional	TC	$72.63	$136.58	$596.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $341.52 / $442.24 / $442.24	Facility	26	$341.52	$442.24	$442.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $161.24 / $281.80 / $1,609.32	Professional		$161.24	$281.80	$1,609.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $53.87 / $73.45 / $379.76	Professional	26	$53.87	$73.45	$379.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $106.38 / $186.65 / $1,331.00	Professional	TC	$106.38	$186.65	$1,331.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $163.76 / $168.53 / $262.50	Facility	26	$163.76	$168.53	$262.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $250.54 / $348.54 / $507.00	Professional		$250.54	$348.54	$507.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $116.86 / $217.13	Professional		$47.10	$116.86	$217.13
United Facility/Professional Professional Modifier Low / Median / High Price $156.76 / $189.70 / $336.26	Professional		$156.76	$189.70	$336.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.02 / $63.66 / $112.54	Professional	26	$51.02	$63.66	$112.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.74 / $125.93 / $241.78	Professional	TC	$105.74	$125.93	$241.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $200.74 / $254.10 / $299.00	Professional		$200.74	$254.10	$299.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.94 / $89.80 / $105.70	Professional	26	$70.94	$89.80	$105.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $129.80 / $164.30 / $193.30	Professional	TC	$129.80	$164.30	$193.30