Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.57 / $89.20 / $244.63	Facility	26	$43.57	$89.20	$244.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.39 / $180.59 / $578.00	Professional		$45.39	$180.59	$578.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.69 / $52.46 / $236.00	Professional	26	$44.69	$52.46	$236.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.74 / $164.27 / $221.14	Professional	TC	$82.74	$164.27	$221.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $149.78 / $154.27 / $158.77	Facility	26	$149.78	$154.27	$158.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.57 / $356.79 / $582.36	Professional		$195.57	$356.79	$582.36
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 $139.87 / $231.33 / $459.91	Professional	TC	$139.87	$231.33	$459.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $116.09 / $214.90 / $689.86	Professional		$116.09	$214.90	$689.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.74 / $72.50 / $166.43	Professional	26	$43.74	$72.50	$166.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.34 / $136.04 / $512.34	Professional	TC	$72.34	$136.04	$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 $160.52 / $280.20 / $1,378.78	Professional		$160.52	$280.20	$1,378.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $51.51 / $68.56 / $300.10	Professional	26	$51.51	$68.56	$300.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $105.66 / $170.39 / $1,332.00	Professional	TC	$105.66	$170.39	$1,332.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $154.27 / $158.77 / $262.50	Facility	26	$154.27	$158.77	$262.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $249.30 / $350.56 / $477.00	Professional		$249.30	$350.56	$477.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $116.86 / $216.59	Professional		$47.10	$116.86	$216.59
United Facility/Professional Professional Modifier Low / Median / High Price $152.28 / $188.86 / $352.37	Professional		$152.28	$188.86	$352.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.42 / $63.77 / $155.41	Professional	26	$51.42	$63.77	$155.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $105.02 / $125.09 / $227.20	Professional	TC	$105.02	$125.09	$227.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $200.27 / $253.50 / $298.20	Professional		$200.27	$253.50	$298.20
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 $129.24 / $163.60 / $192.50	Professional	TC	$129.24	$163.60	$192.50