Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.59 / $85.46 / $239.35	Facility	26	$41.59	$85.46	$239.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.12 / $148.30 / $275.00	Professional		$126.12	$148.30	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.35 / $46.88 / $96.35	Professional	26	$43.35	$46.88	$96.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.15 / $103.82 / $220.00	Professional	TC	$81.15	$103.82	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $145.22 / $149.59 / $153.94	Facility	26	$145.22	$149.59	$153.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.28 / $311.06 / $454.21	Professional		$163.28	$311.06	$454.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.82 / $102.39 / $142.41	Professional	26	$47.82	$102.39	$142.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.98 / $208.66 / $334.60	Professional	TC	$112.98	$208.66	$334.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $116.87 / $216.13 / $493.69	Professional		$116.87	$216.13	$493.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.97 / $68.16 / $140.93	Professional	26	$41.97	$68.16	$140.93
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.90 / $140.85 / $351.92	Professional	TC	$74.90	$140.85	$351.92
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $327.27 / $422.56 / $422.56	Facility	26	$327.27	$422.56	$422.56
Medica Facility/Professional Professional Modifier Low / Median / High Price $149.02 / $255.38 / $1,035.22	Professional		$149.02	$255.38	$1,035.22
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $48.24 / $61.54 / $287.12	Professional	26	$48.24	$61.54	$287.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $97.03 / $138.69 / $780.77	Professional	TC	$97.03	$138.69	$780.77
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $149.59 / $153.94 / $250.14	Facility	26	$149.59	$153.94	$250.14
Midlands Facility/Professional Professional Modifier Low / Median / High Price $209.96 / $283.23 / $450.59	Professional		$209.96	$283.23	$450.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $176.60 / $176.60 / $503.50	Professional		$176.60	$176.60	$503.50
United Facility/Professional Professional Modifier Low / Median / High Price $141.86 / $176.41 / $306.68	Professional		$141.86	$176.41	$306.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.21 / $60.91 / $107.75	Professional	26	$48.21	$60.91	$107.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.67 / $114.87 / $201.12	Professional	TC	$93.67	$114.87	$201.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $201.77 / $255.40 / $300.50	Professional		$201.77	$255.40	$300.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $67.94 / $86.00 / $101.20	Professional	26	$67.94	$86.00	$101.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $133.83 / $169.40 / $199.30	Professional	TC	$133.83	$169.40	$199.30