Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.08 / $168.93 / $309.25	Facility	26	$87.08	$168.93	$309.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.53 / $166.33 / $238.19	Professional		$109.53	$166.33	$238.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.85 / $60.02 / $122.50	Professional	26	$52.85	$60.02	$122.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.47 / $71.22 / $180.05	Professional	TC	$51.47	$71.22	$180.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $171.06 / $176.19 / $181.32	Facility	26	$171.06	$176.19	$181.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.04 / $292.67 / $472.72	Professional		$158.04	$292.67	$472.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.19 / $144.28 / $200.67	Professional	26	$65.19	$144.28	$200.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.61 / $152.53 / $331.76	Professional	TC	$82.61	$152.53	$331.76
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.65 / $196.14 / $852.85	Professional		$112.65	$196.14	$852.85
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.71 / $93.85 / $220.54	Professional	26	$62.71	$93.85	$220.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.94 / $87.84 / $753.03	Professional	TC	$49.94	$87.84	$753.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $176.19 / $302.75 / $302.75	Facility	26	$176.19	$302.75	$302.75
Medica Facility/Professional Professional Modifier Low / Median / High Price $142.82 / $255.23 / $3,098.01	Professional		$142.82	$255.23	$3,098.01
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.14 / $87.03 / $636.41	Professional	26	$63.14	$87.03	$636.41
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.31 / $118.41 / $2,808.09	Professional	TC	$69.31	$118.41	$2,808.09
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $176.19 / $181.32 / $356.70	Facility	26	$176.19	$181.32	$356.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $233.40 / $292.67 / $804.00	Professional		$233.40	$292.67	$804.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $163.80 / $163.80 / $521.29	Professional		$163.80	$163.80	$521.29
United Facility/Professional Professional Modifier Low / Median / High Price $129.84 / $169.08 / $279.61	Professional		$129.84	$169.08	$279.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.49 / $84.27 / $134.46	Professional	26	$63.49	$84.27	$134.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.01 / $83.58 / $194.12	Professional	TC	$63.01	$83.58	$194.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $169.61 / $214.70 / $252.60	Professional		$169.61	$214.70	$252.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $90.22 / $114.20 / $134.30	Professional	26	$90.22	$114.20	$134.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $79.40 / $100.50 / $118.20	Professional	TC	$79.40	$100.50	$118.20