Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.43 / $168.75 / $462.31	Facility	26	$82.43	$168.75	$462.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.30 / $301.70 / $482.09	Professional		$257.30	$301.70	$482.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $90.40 / $219.90	Professional	26	$55.00	$90.40	$219.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.49 / $220.00 / $380.41	Professional	TC	$168.49	$220.00	$380.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $282.58 / $291.07 / $299.55	Facility	26	$282.58	$291.07	$299.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $399.79 / $769.49 / $1,130.54	Professional		$399.79	$769.49	$1,130.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.79 / $202.46 / $276.54	Professional	26	$94.79	$202.46	$276.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $302.83 / $567.04 / $897.03	Professional	TC	$302.83	$567.04	$897.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $286.58 / $493.20 / $1,343.37	Professional		$286.58	$493.20	$1,343.37
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.13 / $136.01 / $289.38	Professional	26	$83.13	$136.01	$289.38
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $203.44 / $357.83 / $911.27	Professional	TC	$203.44	$357.83	$911.27
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $649.67 / $833.76 / $833.76	Facility	26	$649.67	$833.76	$833.76
Medica Facility/Professional Professional Modifier Low / Median / High Price $364.78 / $575.39 / $2,878.66	Professional		$364.78	$575.39	$2,878.66
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $93.73 / $119.65 / $561.99	Professional	26	$93.73	$119.65	$561.99
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $263.70 / $379.37 / $2,400.63	Professional	TC	$263.70	$379.37	$2,400.63
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $291.07 / $299.55 / $494.58	Facility	26	$291.07	$299.55	$494.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $499.49 / $654.37 / $923.82	Professional		$499.49	$654.37	$923.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.30 / $237.71 / $537.02	Professional		$89.30	$237.71	$537.02
United Facility/Professional Professional Modifier Low / Median / High Price $347.69 / $431.84 / $756.09	Professional		$347.69	$431.84	$756.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $92.27 / $110.26 / $208.96	Professional	26	$92.27	$110.26	$208.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.15 / $312.19 / $542.71	Professional	TC	$255.15	$312.19	$542.71
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $498.33 / $630.79 / $742.20	Professional		$498.33	$630.79	$742.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $134.85 / $170.70 / $200.80	Professional	26	$134.85	$170.70	$200.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $363.48 / $460.10 / $541.29	Professional	TC	$363.48	$460.10	$541.29