Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.39 / $65.29 / $80.55	Facility	26	$42.39	$65.29	$80.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.03 / $176.75 / $718.40	Professional		$138.03	$176.75	$718.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.40 / $49.32 / $116.16	Professional	26	$42.40	$49.32	$116.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.64 / $120.78 / $246.29	Professional	TC	$95.64	$120.78	$246.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $154.49 / $159.12 / $163.76	Facility	26	$154.49	$159.12	$163.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.66 / $372.34 / $465.42	Professional		$175.66	$372.34	$465.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.99 / $107.05 / $133.81	Professional	26	$46.99	$107.05	$133.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.03 / $265.29 / $331.61	Professional	TC	$122.03	$265.29	$331.61
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $156.43 / $207.84 / $729.12	Professional		$156.43	$207.84	$729.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.93 / $63.38 / $144.16	Professional	26	$47.93	$63.38	$144.16
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $108.50 / $144.94 / $519.62	Professional	TC	$108.50	$144.94	$519.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $159.12 / $211.96 / $211.96	Facility	26	$159.12	$211.96	$211.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.93 / $240.51 / $725.65	Professional		$173.93	$240.51	$725.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $49.96 / $63.77 / $300.10	Professional	26	$49.96	$63.77	$300.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $114.51 / $144.65 / $724.19	Professional	TC	$114.51	$144.65	$724.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $159.12 / $163.76 / $262.50	Facility	26	$159.12	$163.76	$262.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $290.10 / $338.03 / $537.78	Professional		$290.10	$338.03	$537.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.10 / $142.21 / $259.50	Professional		$47.10	$142.21	$259.50
United Facility/Professional Professional Modifier Low / Median / High Price $158.12 / $205.90 / $500.27	Professional		$158.12	$205.90	$500.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.97 / $60.13 / $105.78	Professional	26	$48.97	$60.13	$105.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.15 / $142.13 / $235.76	Professional	TC	$109.15	$142.13	$235.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $231.23 / $292.70 / $344.40	Professional		$231.23	$292.70	$344.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $68.18 / $86.30 / $101.50	Professional	26	$68.18	$86.30	$101.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $163.06 / $206.40 / $242.90	Professional	TC	$163.06	$206.40	$242.90