Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.14 / $72.39 / $171.23	Facility	26	$39.14	$72.39	$171.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.14 / $130.41 / $613.00	Professional		$109.14	$130.41	$613.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $40.15 / $88.18	Professional	26	$31.76	$40.15	$88.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.23 / $89.70 / $177.96	Professional	TC	$79.23	$89.70	$177.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.55 / $106.66 / $109.76	Facility	26	$103.55	$106.66	$109.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.48 / $320.36 / $400.46	Professional		$121.48	$320.36	$400.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.18 / $96.19 / $120.23	Professional	26	$39.18	$96.19	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.61 / $224.18 / $280.22	Professional	TC	$85.61	$224.18	$280.22
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $119.66 / $177.42 / $316.12	Professional		$119.66	$177.42	$316.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $60.17 / $109.47	Professional	26	$39.36	$60.17	$109.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.29 / $121.65 / $206.65	Professional	TC	$80.29	$121.65	$206.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $106.66 / $190.76 / $190.76	Facility	26	$106.66	$190.76	$190.76
Medica Facility/Professional Professional Modifier Low / Median / High Price $129.63 / $198.00 / $927.52	Professional		$129.63	$198.00	$927.52
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.14 / $57.36 / $268.38	Professional	26	$38.14	$57.36	$268.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $85.58 / $113.47 / $659.08	Professional	TC	$85.58	$113.47	$659.08
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $106.66 / $109.76 / $235.68	Facility	26	$106.66	$109.76	$235.68
Midlands Facility/Professional Professional Modifier Low / Median / High Price $177.00 / $271.92 / $368.51	Professional		$177.00	$271.92	$368.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.52 / $126.75 / $223.55	Professional		$42.52	$126.75	$223.55
United Facility/Professional Professional Modifier Low / Median / High Price $128.99 / $168.80 / $323.35	Professional		$128.99	$168.80	$323.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.70 / $52.86 / $88.63	Professional	26	$39.70	$52.86	$88.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.58 / $107.79 / $187.97	Professional	TC	$85.58	$107.79	$187.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $184.47 / $233.50 / $274.70	Professional		$184.47	$233.50	$274.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $56.80 / $71.90 / $84.60	Professional	26	$56.80	$71.90	$84.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $127.66 / $161.60 / $190.10	Professional	TC	$127.66	$161.60	$190.10