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 / $152.16	Facility	26	$46.95	$89.20	$152.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.37 / $231.53 / $982.97	Professional		$129.37	$231.53	$982.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $52.29 / $247.00	Professional	26	$44.14	$52.29	$247.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.42 / $159.68 / $254.36	Professional	TC	$82.42	$159.68	$254.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $148.05 / $152.49 / $156.93	Facility	26	$148.05	$152.49	$156.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.78 / $357.49 / $589.48	Professional		$197.78	$357.49	$589.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $107.05 / $159.57	Professional	26	$49.68	$107.05	$159.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.33 / $233.86 / $467.02	Professional	TC	$139.33	$233.86	$467.02
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $115.81 / $214.36 / $748.22	Professional		$115.81	$214.36	$748.22
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.74 / $77.31 / $174.65	Professional	26	$43.74	$77.31	$174.65
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.06 / $135.50 / $594.30	Professional	TC	$72.06	$135.50	$594.30
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 $160.52 / $280.39 / $1,609.32	Professional		$160.52	$280.39	$1,609.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $51.51 / $68.87 / $379.76	Professional	26	$51.51	$68.87	$379.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $105.66 / $185.40 / $1,345.00	Professional	TC	$105.66	$185.40	$1,345.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $152.49 / $156.93 / $262.50	Facility	26	$152.49	$156.93	$262.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $248.68 / $350.04 / $505.00	Professional		$248.68	$350.04	$505.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $116.86 / $216.07	Professional		$47.10	$116.86	$216.07
United Facility/Professional Professional Modifier Low / Median / High Price $149.47 / $188.86 / $346.53	Professional		$149.47	$188.86	$346.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $61.50 / $111.65	Professional	26	$49.96	$61.50	$111.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.66 / $125.09 / $233.91	Professional	TC	$105.66	$125.09	$233.91
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $199.71 / $252.80 / $297.50	Professional		$199.71	$252.80	$297.50
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 $128.77 / $163.00 / $191.80	Professional	TC	$128.77	$163.00	$191.80