Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.20 / $109.21 / $298.77	Facility	26	$53.20	$109.21	$298.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.96 / $275.00 / $347.11	Professional		$168.96	$275.00	$347.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $58.24 / $128.75	Professional	26	$52.46	$58.24	$128.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.48 / $179.66 / $285.86	Professional	TC	$111.48	$179.66	$285.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.35 / $186.79 / $192.23	Facility	26	$181.35	$186.79	$192.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $246.50 / $406.37 / $734.71	Professional		$246.50	$406.37	$734.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.69 / $131.09 / $179.45	Professional	26	$60.69	$131.09	$179.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.64 / $281.12 / $585.21	Professional	TC	$169.64	$281.12	$585.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $150.46 / $278.56 / $937.61	Professional		$150.46	$278.56	$937.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.42 / $86.34 / $305.76	Professional	26	$53.42	$86.34	$305.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.04 / $182.29 / $728.13	Professional	TC	$97.04	$182.29	$728.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $417.20 / $540.32 / $540.32	Facility	26	$417.20	$540.32	$540.32
Medica Facility/Professional Professional Modifier Low / Median / High Price $202.44 / $353.08 / $1,882.38	Professional		$202.44	$353.08	$1,882.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.88 / $77.72 / $434.24	Professional	26	$60.88	$77.72	$434.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $135.55 / $229.41 / $1,576.92	Professional	TC	$135.55	$229.41	$1,576.92
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $186.79 / $192.23 / $320.76	Facility	26	$186.79	$192.23	$320.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $324.55 / $465.30 / $606.00	Professional		$324.55	$465.30	$606.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.36 / $159.11 / $281.19	Professional		$57.36	$159.11	$281.19
United Facility/Professional Professional Modifier Low / Median / High Price $196.76 / $238.19 / $417.03	Professional		$196.76	$238.19	$417.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.68 / $73.43 / $136.07	Professional	26	$59.68	$73.43	$136.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.76 / $160.47 / $300.10	Professional	TC	$131.76	$160.47	$300.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $260.07 / $329.20 / $387.30	Professional		$260.07	$329.20	$387.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $86.66 / $109.70 / $129.10	Professional	26	$86.66	$109.70	$129.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $173.41 / $219.50 / $258.20	Professional	TC	$173.41	$219.50	$258.20