Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.76 / $115.63 / $213.74	Facility	26	$49.76	$115.63	$213.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.24 / $140.74 / $262.38	Professional		$125.24	$140.74	$262.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.23 / $34.67 / $171.64	Professional	26	$31.23	$34.67	$171.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $106.08 / $166.22	Professional	TC	$96.93	$106.08	$166.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.39 / $116.79 / $120.19	Facility	26	$113.39	$116.79	$120.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.05 / $343.64 / $429.54	Professional		$140.05	$343.64	$429.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.94 / $81.45 / $101.81	Professional	26	$36.94	$81.45	$101.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.27 / $262.19 / $327.73	Professional	TC	$101.27	$262.19	$327.73
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $127.34 / $203.51 / $478.63	Professional		$127.34	$203.51	$478.63
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.42 / $51.51 / $108.00	Professional	26	$33.42	$51.51	$108.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.92 / $146.93 / $268.63	Professional	TC	$93.92	$146.93	$268.63
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $116.79 / $161.97 / $161.97	Facility	26	$116.79	$161.97	$161.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $139.21 / $233.77 / $968.58	Professional		$139.21	$233.77	$968.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $48.65 / $227.63	Professional	26	$37.36	$48.65	$227.63
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $100.53 / $141.05 / $740.95	Professional	TC	$100.53	$141.05	$740.95
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $116.79 / $120.19 / $198.54	Facility	26	$116.79	$120.19	$198.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $231.00 / $311.70 / $466.21	Professional		$231.00	$311.70	$466.21
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $195.80 / $195.80 / $435.30	Professional		$195.80	$195.80	$435.30
United Facility/Professional Professional Modifier Low / Median / High Price $138.40 / $174.82 / $320.50	Professional		$138.40	$174.82	$320.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.36 / $44.84 / $81.73	Professional	26	$37.36	$44.84	$81.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.90 / $140.81 / $236.94	Professional	TC	$102.90	$140.81	$236.94
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $205.16 / $259.70 / $305.50	Professional		$205.16	$259.70	$305.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $63.40 / $74.59	Professional	26	$50.09	$63.40	$74.59
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $155.00 / $196.20 / $230.90	Professional	TC	$155.00	$196.20	$230.90