Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.70 / $147.01 / $272.07	Facility	26	$91.70	$147.01	$272.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.34 / $137.09 / $545.80	Professional		$88.34	$137.09	$545.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $74.72 / $289.82	Professional	26	$40.96	$74.72	$289.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.31 / $62.37 / $255.99	Professional	TC	$40.31	$62.37	$255.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $148.04 / $152.47 / $156.91	Facility	26	$148.04	$152.47	$156.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.32 / $221.85 / $277.31	Professional		$186.32	$221.85	$277.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.42 / $115.58 / $144.47	Professional	26	$100.42	$115.58	$144.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.91 / $106.27 / $132.84	Professional	TC	$85.91	$106.27	$132.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $84.97 / $156.38 / $545.71	Professional		$84.97	$156.38	$545.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.66 / $76.14 / $285.55	Professional	26	$46.66	$76.14	$285.55
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.31 / $71.89 / $264.98	Professional	TC	$38.31	$71.89	$264.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $152.47 / $152.47 / $152.47	Facility	26	$152.47	$152.47	$152.47
Medica Facility/Professional Professional Modifier Low / Median / High Price $98.86 / $176.40 / $713.23	Professional		$98.86	$176.40	$713.23
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.76 / $64.81 / $493.68	Professional	26	$54.76	$64.81	$493.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $44.10 / $61.75 / $900.73	Professional	TC	$44.10	$61.75	$900.73
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $152.47 / $156.91 / $279.12	Facility	26	$152.47	$156.91	$279.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $178.29 / $206.94 / $323.79	Professional		$178.29	$206.94	$323.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $44.99 / $86.03 / $158.60	Professional		$44.99	$86.03	$158.60
United Facility/Professional Professional Modifier Low / Median / High Price $98.86 / $117.03 / $191.91	Professional		$98.86	$117.03	$191.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.03 / $64.81 / $105.14	Professional	26	$54.03	$64.81	$105.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.10 / $60.14 / $94.68	Professional	TC	$44.10	$60.14	$94.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $139.19 / $176.20 / $207.40	Professional		$139.19	$176.20	$207.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $73.55 / $93.10 / $109.50	Professional	26	$73.55	$93.10	$109.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $65.73 / $83.20 / $97.90	Professional	TC	$65.73	$83.20	$97.90