Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.54 / $114.03 / $312.10	Facility	26	$55.54	$114.03	$312.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $228.67 / $303.77 / $1,249.00	Professional		$228.67	$303.77	$1,249.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $63.10 / $310.38	Professional	26	$55.00	$63.10	$310.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.65 / $229.98 / $362.33	Professional	TC	$168.65	$229.98	$362.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $188.16 / $193.80 / $199.45	Facility	26	$188.16	$193.80	$199.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $287.91 / $550.75 / $794.52	Professional		$287.91	$550.75	$794.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.64 / $136.52 / $192.11	Professional	26	$63.64	$136.52	$192.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $215.54 / $414.22 / $637.89	Professional	TC	$215.54	$414.22	$637.89
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $204.29 / $379.58 / $880.39	Professional		$204.29	$379.58	$880.39
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $90.77 / $200.81	Professional	26	$55.90	$90.77	$200.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.38 / $279.02 / $708.63	Professional	TC	$148.38	$279.02	$708.63
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $436.88 / $565.04 / $565.04	Facility	26	$436.88	$565.04	$565.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $253.96 / $445.58 / $1,846.75	Professional		$253.96	$445.58	$1,846.75
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.72 / $81.34 / $444.14	Professional	26	$63.72	$81.34	$444.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $185.25 / $266.52 / $2,104.00	Professional	TC	$185.25	$266.52	$2,104.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $193.80 / $199.45 / $334.74	Facility	26	$193.80	$199.45	$334.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $443.33 / $505.75 / $794.75	Professional		$443.33	$505.75	$794.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.51 / $200.37 / $389.70	Professional		$60.51	$200.37	$389.70
United Facility/Professional Professional Modifier Low / Median / High Price $242.41 / $300.64 / $526.38	Professional		$242.41	$300.64	$526.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.72 / $81.34 / $142.41	Professional	26	$63.72	$81.34	$142.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $185.25 / $219.34 / $383.97	Professional	TC	$185.25	$219.34	$383.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $355.90 / $450.50 / $530.00	Professional		$355.90	$450.50	$530.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $90.77 / $114.90 / $135.10	Professional	26	$90.77	$114.90	$135.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $265.12 / $335.60 / $394.90	Professional	TC	$265.12	$335.60	$394.90