Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.20 / $89.20 / $244.63	Facility	26	$89.20	$89.20	$244.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.54 / $207.20 / $578.00	Professional		$49.54	$207.20	$578.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.49 / $50.02 / $232.72	Professional	26	$44.49	$50.02	$232.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.21 / $177.61 / $303.82	Professional	TC	$100.21	$177.61	$303.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $152.21 / $156.78 / $161.34	Facility	26	$152.21	$156.78	$161.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.61 / $383.97 / $582.36	Professional		$199.61	$383.97	$582.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.68 / $107.05 / $147.44	Professional	26	$49.68	$107.05	$147.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.47 / $276.92 / $457.06	Professional	TC	$154.47	$276.92	$457.06
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $142.77 / $264.88 / $684.43	Professional		$142.77	$264.88	$684.43
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.74 / $72.50 / $171.22	Professional	26	$43.74	$72.50	$171.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $99.03 / $186.01 / $512.34	Professional	TC	$99.03	$186.01	$512.34
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 $183.66 / $314.74 / $1,378.78	Professional		$183.66	$314.74	$1,378.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $51.50 / $64.56 / $300.10	Professional	26	$51.50	$64.56	$300.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $129.79 / $191.57 / $1,103.98	Professional	TC	$129.79	$191.57	$1,103.98
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $156.78 / $161.34 / $262.50	Facility	26	$156.78	$161.34	$262.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $287.66 / $350.56 / $530.97	Professional		$287.66	$350.56	$530.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $117.81 / $266.93	Professional		$47.10	$117.81	$266.93
United Facility/Professional Professional Modifier Low / Median / High Price $172.45 / $217.42 / $380.67	Professional		$172.45	$217.42	$380.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $61.50 / $111.34	Professional	26	$49.96	$61.50	$111.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.44 / $153.65 / $287.33	Professional	TC	$124.44	$153.65	$287.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $247.90 / $313.80 / $369.20	Professional		$247.90	$313.80	$369.20
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 $176.96 / $224.00 / $263.50	Professional	TC	$176.96	$224.00	$263.50