Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.02 / $185.45 / $342.84	Facility	26	$118.02	$185.45	$342.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.07 / $275.00 / $370.38	Professional		$170.07	$275.00	$370.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.44 / $58.86 / $133.97	Professional	26	$54.44	$58.86	$133.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.43 / $155.36 / $282.18	Professional	TC	$112.43	$155.36	$282.18
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 / $409.48 / $734.71	Professional		$246.50	$409.48	$734.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.19 / $131.09 / $179.45	Professional	26	$61.19	$131.09	$179.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $171.63 / $284.29 / $585.21	Professional	TC	$171.63	$284.29	$585.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.88 / $280.97 / $890.51	Professional		$151.88	$280.97	$890.51
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.72 / $87.33 / $266.76	Professional	26	$53.72	$87.33	$266.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $98.18 / $184.42 / $728.13	Professional	TC	$98.18	$184.42	$728.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $419.92 / $542.79 / $542.79	Facility	26	$419.92	$542.79	$542.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $203.89 / $355.54 / $1,884.77	Professional		$203.89	$355.54	$1,884.77
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 $136.99 / $229.41 / $1,950.00	Professional	TC	$136.99	$229.41	$1,950.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $186.79 / $192.23 / $321.36	Facility	26	$186.79	$192.23	$321.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $326.61 / $465.30 / $606.00	Professional		$326.61	$465.30	$606.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.67 / $160.02 / $284.33	Professional		$57.67	$160.02	$284.33
United Facility/Professional Professional Modifier Low / Median / High Price $202.64 / $279.92 / $483.96	Professional		$202.64	$279.92	$483.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.11 / $75.72 / $135.61	Professional	26	$60.11	$75.72	$135.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.31 / $165.00 / $311.35	Professional	TC	$133.31	$165.00	$311.35
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $262.60 / $332.40 / $391.10	Professional		$262.60	$332.40	$391.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $87.22 / $110.40 / $129.90	Professional	26	$87.22	$110.40	$129.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $175.38 / $222.00 / $261.20	Professional	TC	$175.38	$222.00	$261.20