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 $161.94 / $232.52 / $340.53	Professional		$161.94	$232.52	$340.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.73 / $58.49 / $277.00	Professional	26	$51.73	$58.49	$277.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.11 / $180.68 / $279.66	Professional	TC	$112.11	$180.68	$279.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $172.91 / $178.10 / $183.28	Facility	26	$172.91	$178.10	$183.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.99 / $400.95 / $721.89	Professional		$241.99	$400.95	$721.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.88 / $124.89 / $170.89	Professional	26	$57.88	$124.89	$170.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $170.63 / $274.79 / $578.08	Professional	TC	$170.63	$274.79	$578.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $148.52 / $275.05 / $768.50	Professional		$148.52	$275.05	$768.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.91 / $82.43 / $202.58	Professional	26	$50.91	$82.43	$202.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.61 / $183.35 / $604.04	Professional	TC	$97.61	$183.35	$604.04
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 $200.60 / $349.79 / $1,638.03	Professional		$200.60	$349.79	$1,638.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.84 / $73.83 / $376.34	Professional	26	$57.84	$73.83	$376.34
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $136.99 / $217.68 / $1,335.34	Professional	TC	$136.99	$217.68	$1,335.34
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $178.10 / $183.28 / $305.33	Facility	26	$178.10	$183.28	$305.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $320.49 / $439.61 / $574.00	Professional		$320.49	$439.61	$574.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.74 / $156.80 / $277.73	Professional		$54.74	$156.80	$277.73
United Facility/Professional Professional Modifier Low / Median / High Price $196.69 / $236.01 / $453.10	Professional		$196.69	$236.01	$453.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.75 / $70.02 / $129.22	Professional	26	$56.75	$70.02	$129.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.76 / $165.00 / $288.13	Professional	TC	$130.76	$165.00	$288.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $257.07 / $325.39 / $382.80	Professional		$257.07	$325.39	$382.80
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 $174.43 / $220.80 / $259.70	Professional	TC	$174.43	$220.80	$259.70