Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.43 / $193.63 / $357.75	Facility	26	$96.43	$193.63	$357.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.17 / $235.83 / $403.92	Professional		$198.17	$235.83	$403.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.56 / $60.02 / $85.67	Professional	26	$54.56	$60.02	$85.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.32 / $168.78 / $325.77	Professional	TC	$137.32	$168.78	$325.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $190.61 / $196.33 / $202.05	Facility	26	$190.61	$196.33	$202.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $294.19 / $477.58 / $887.06	Professional		$294.19	$477.58	$887.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.31 / $135.75 / $203.95	Professional	26	$63.31	$135.75	$203.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.89 / $348.77 / $731.86	Professional	TC	$208.89	$348.77	$731.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $175.07 / $324.51 / $1,086.25	Professional		$175.07	$324.51	$1,086.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.62 / $90.26 / $269.27	Professional	26	$55.62	$90.26	$269.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $119.45 / $224.51 / $885.46	Professional	TC	$119.45	$224.51	$885.46
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $434.48 / $561.91 / $561.91	Facility	26	$434.48	$561.91	$561.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $237.04 / $422.90 / $2,293.84	Professional		$237.04	$422.90	$2,293.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.05 / $80.48 / $523.40	Professional	26	$63.05	$80.48	$523.40
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $167.60 / $287.25 / $2,412.00	Professional	TC	$167.60	$287.25	$2,412.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $196.33 / $202.05 / $332.94	Facility	26	$196.33	$202.05	$332.94
Midlands Facility/Professional Professional Modifier Low / Median / High Price $380.09 / $546.13 / $735.00	Professional		$380.09	$546.13	$735.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.65 / $185.17 / $327.51	Professional		$59.65	$185.17	$327.51
United Facility/Professional Professional Modifier Low / Median / High Price $224.88 / $279.33 / $520.65	Professional		$224.88	$279.33	$520.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.81 / $74.17 / $140.93	Professional	26	$61.81	$74.17	$140.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $167.60 / $228.54 / $970.32	Professional	TC	$167.60	$228.54	$970.32
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $303.68 / $384.40 / $452.20	Professional		$303.68	$384.40	$452.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $90.22 / $114.20 / $134.40	Professional	26	$90.22	$114.20	$134.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $213.46 / $270.20 / $317.89	Professional	TC	$213.46	$270.20	$317.89