Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.82 / $101.82 / $104.98	Facility	26	$101.82	$101.82	$104.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $200.08 / $277.62 / $655.39	Professional		$200.08	$277.62	$655.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.45 / $77.39 / $154.00	Professional	26	$65.45	$77.39	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.91 / $158.32 / $348.53	Professional	TC	$131.91	$158.32	$348.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $225.21 / $231.97 / $238.72	Facility	26	$225.21	$231.97	$238.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $233.50 / $520.49 / $698.97	Professional		$233.50	$520.49	$698.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.59 / $171.43 / $229.39	Professional	26	$75.59	$171.43	$229.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.65 / $349.07 / $468.39	Professional	TC	$163.65	$349.07	$468.39
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $219.53 / $303.14 / $1,143.38	Professional		$219.53	$303.14	$1,143.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.17 / $107.99 / $396.79	Professional	26	$77.17	$107.99	$396.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.03 / $195.15 / $616.67	Professional	TC	$144.03	$195.15	$616.67
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $549.04 / $707.68 / $707.68	Facility	26	$549.04	$707.68	$707.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $282.66 / $471.10 / $1,484.56	Professional		$282.66	$471.10	$1,484.56
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $81.92 / $117.42 / $478.82	Professional	26	$81.92	$117.42	$478.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $188.72 / $314.54 / $1,005.68	Professional	TC	$188.72	$314.54	$1,005.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $231.97 / $238.72 / $420.00	Facility	26	$231.97	$238.72	$420.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $427.43 / $473.22 / $752.85	Professional		$427.43	$473.22	$752.85
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.30 / $204.31 / $364.55	Professional		$75.30	$204.31	$364.55
United Facility/Professional Professional Modifier Low / Median / High Price $255.51 / $408.82 / $912.19	Professional		$255.51	$408.82	$912.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.92 / $117.42 / $237.33	Professional	26	$81.92	$117.42	$237.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.59 / $275.22 / $743.48	Professional	TC	$173.59	$275.22	$743.48
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $391.05 / $495.00 / $582.40	Professional		$391.05	$495.00	$582.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $132.33 / $167.50 / $197.10	Professional	26	$132.33	$167.50	$197.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $258.73 / $327.50 / $385.40	Professional	TC	$258.73	$327.50	$385.40