Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.79 / $102.67 / $190.09	Facility	26	$67.79	$102.67	$190.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $141.90 / $406.00	Professional		$118.48	$141.90	$406.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.91 / $32.46 / $177.00	Professional	26	$28.91	$32.46	$177.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $98.57 / $171.36	Professional	TC	$87.95	$98.57	$171.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.61 / $106.72 / $109.83	Facility	26	$103.61	$106.72	$109.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $116.98 / $395.10 / $580.80	Professional		$116.98	$395.10	$580.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.97 / $74.47 / $103.57	Professional	26	$37.97	$74.47	$103.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.52 / $273.22 / $487.72	Professional	TC	$86.52	$273.22	$487.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $164.43 / $233.45 / $436.70	Professional		$164.43	$233.45	$436.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $48.08 / $91.78	Professional	26	$30.00	$48.08	$91.78
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.65 / $170.91 / $339.59	Professional	TC	$102.65	$170.91	$339.59
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $106.72 / $147.81 / $147.81	Facility	26	$106.72	$147.81	$147.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $132.13 / $205.52 / $898.89	Professional		$132.13	$205.52	$898.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.06 / $43.05 / $371.50	Professional	26	$33.06	$43.05	$371.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $94.55 / $148.11 / $695.99	Professional	TC	$94.55	$148.11	$695.99
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $106.72 / $109.83 / $181.80	Facility	26	$106.72	$109.83	$181.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.00 / $270.95 / $480.02	Professional		$169.00	$270.95	$480.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $31.96 / $118.46 / $292.35	Professional		$31.96	$118.46	$292.35
United Facility/Professional Professional Modifier Low / Median / High Price $131.19 / $176.16 / $339.29	Professional		$131.19	$176.16	$339.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.06 / $41.15 / $83.26	Professional	26	$33.06	$41.15	$83.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.76 / $136.49 / $243.87	Professional	TC	$92.76	$136.49	$243.87
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $275.87 / $349.20 / $410.80	Professional		$275.87	$349.20	$410.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $44.95 / $56.90 / $67.00	Professional	26	$44.95	$56.90	$67.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $230.92 / $292.30 / $343.90	Professional	TC	$230.92	$292.30	$343.90