Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.65 / $104.02 / $283.99	Facility	26	$50.65	$104.02	$283.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.40 / $280.72 / $1,183.00	Professional		$223.40	$280.72	$1,183.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.02 / $57.59 / $228.00	Professional	26	$52.02	$57.59	$228.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.65 / $220.00 / $333.10	Professional	TC	$168.65	$220.00	$333.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $172.73 / $177.91 / $183.09	Facility	26	$172.73	$177.91	$183.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.98 / $542.21 / $694.85	Professional		$281.98	$542.21	$694.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.88 / $124.89 / $175.86	Professional	26	$57.88	$124.89	$175.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $210.38 / $417.33 / $552.46	Professional	TC	$210.38	$417.33	$552.46
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $200.44 / $372.88 / $850.57	Professional		$200.44	$372.88	$850.57
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.91 / $82.43 / $190.00	Professional	26	$50.91	$82.43	$190.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $149.52 / $281.17 / $695.69	Professional	TC	$149.52	$281.17	$695.69
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $397.76 / $514.88 / $514.88	Facility	26	$397.76	$514.88	$514.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $248.34 / $435.72 / $1,817.09	Professional		$248.34	$435.72	$1,817.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $73.83 / $364.90	Professional	26	$57.84	$73.83	$364.90
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $185.97 / $253.59 / $1,526.12	Professional	TC	$185.97	$253.59	$1,526.12
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $177.91 / $183.09 / $305.33	Facility	26	$177.91	$183.09	$305.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $433.20 / $493.96 / $781.17	Professional		$433.20	$493.96	$781.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.74 / $199.29 / $374.73	Professional		$54.74	$199.29	$374.73
United Facility/Professional Professional Modifier Low / Median / High Price $246.41 / $293.98 / $494.63	Professional		$246.41	$293.98	$494.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.97 / $73.83 / $163.92	Professional	26	$56.97	$73.83	$163.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $184.46 / $220.19 / $375.31	Professional	TC	$184.46	$220.19	$375.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $349.81 / $442.80 / $521.00	Professional		$349.81	$442.80	$521.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $82.63 / $104.60 / $123.10	Professional	26	$82.63	$104.60	$123.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $267.18 / $338.20 / $397.90	Professional	TC	$267.18	$338.20	$397.90