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 $169.28 / $275.00 / $367.69	Professional		$169.28	$275.00	$367.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.16 / $58.50 / $133.97	Professional	26	$54.16	$58.50	$133.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.79 / $154.05 / $281.42	Professional	TC	$111.79	$154.05	$281.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $180.86 / $186.29 / $191.71	Facility	26	$180.86	$186.29	$191.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.93 / $406.37 / $733.28	Professional		$245.93	$406.37	$733.28
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 $170.63 / $282.18 / $583.78	Professional	TC	$170.63	$282.18	$583.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.03 / $279.63 / $911.26	Professional		$151.03	$279.63	$911.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.42 / $86.34 / $236.30	Professional	26	$53.42	$86.34	$236.30
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.61 / $183.35 / $727.17	Professional	TC	$97.61	$183.35	$727.17
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 $202.80 / $353.63 / $1,882.38	Professional		$202.80	$353.63	$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 $135.90 / $229.41 / $1,906.00	Professional	TC	$135.90	$229.41	$1,906.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $186.29 / $191.71 / $320.76	Facility	26	$186.29	$191.71	$320.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $325.17 / $463.93 / $605.00	Professional		$325.17	$463.93	$605.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.36 / $159.41 / $282.24	Professional		$57.36	$159.41	$282.24
United Facility/Professional Professional Modifier Low / Median / High Price $188.91 / $238.60 / $423.03	Professional		$188.91	$238.60	$423.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.68 / $73.28 / $136.07	Professional	26	$59.68	$73.28	$136.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.53 / $163.69 / $300.91	Professional	TC	$132.53	$163.69	$300.91
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $261.10 / $330.50 / $388.80	Professional		$261.10	$330.50	$388.80
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 $174.43 / $220.80 / $259.70	Professional	TC	$174.43	$220.80	$259.70