Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.92 / $131.77 / $243.74	Facility	26	$56.92	$131.77	$243.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $709.48 / $709.48 / $799.14	Professional		$709.48	$709.48	$799.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $257.12 / $257.12 / $266.93	Professional	26	$257.12	$257.12	$266.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $452.37 / $452.37 / $532.16	Professional	TC	$452.37	$452.37	$532.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $280.02 / $280.02 / $350.03	Professional		$280.02	$280.02	$350.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.94 / $103.94 / $129.93	Professional	26	$103.94	$103.94	$129.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $176.08 / $176.08 / $220.10	Professional	TC	$176.08	$176.08	$220.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $146.87 / $465.81	Professional		$105.00	$146.87	$465.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.01 / $58.25 / $243.49	Professional	26	$42.01	$58.25	$243.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.99 / $88.61 / $331.94	Professional	TC	$62.99	$88.61	$331.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $132.44 / $132.44 / $132.44	Facility	26	$132.44	$132.44	$132.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $126.60 / $190.61 / $636.74	Professional		$126.60	$190.61	$636.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.62 / $55.43 / $190.53	Professional	26	$41.62	$55.43	$190.53
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $77.95 / $104.95 / $601.55	Professional	TC	$77.95	$104.95	$601.55
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $132.44 / $136.29 / $248.64	Facility	26	$132.44	$136.29	$248.64
Midlands Facility/Professional Professional Modifier Low / Median / High Price $224.75 / $257.07 / $352.07	Professional		$224.75	$257.07	$352.07
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.76 / $81.84 / $194.19	Professional		$43.76	$81.84	$194.19
United Facility/Professional Professional Modifier Low / Median / High Price $125.48 / $142.08 / $228.66	Professional		$125.48	$142.08	$228.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.62 / $53.08 / $99.11	Professional	26	$41.62	$53.08	$99.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.40 / $92.27 / $144.66	Professional	TC	$74.40	$92.27	$144.66
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $181.46 / $229.70 / $270.30	Professional		$181.46	$229.70	$270.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $68.97 / $87.30 / $102.70	Professional	26	$68.97	$87.30	$102.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $112.58 / $142.50 / $167.60	Professional	TC	$112.58	$142.50	$167.60