Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.11 / $63.08 / $193.05	Facility	26	$34.11	$63.08	$193.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $265.48 / $405.35 / $1,502.00	Professional		$265.48	$405.35	$1,502.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.20 / $55.26 / $189.26	Professional	26	$33.20	$55.26	$189.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $232.28 / $250.35 / $1,191.00	Professional	TC	$232.28	$250.35	$1,191.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.62 / $121.15 / $124.68	Facility	26	$117.62	$121.15	$124.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $631.92 / $699.68 / $874.60	Professional		$631.92	$699.68	$874.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.28 / $83.78 / $104.72	Professional	26	$78.28	$83.78	$104.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $553.65 / $615.91 / $769.88	Professional	TC	$553.65	$615.91	$769.88
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $255.15 / $398.36 / $649.29	Professional		$255.15	$398.36	$649.29
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.39 / $56.30 / $104.50	Professional	26	$34.39	$56.30	$104.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.76 / $345.41 / $544.79	Professional	TC	$220.76	$345.41	$544.79
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $121.15 / $121.15 / $121.15	Facility	26	$121.15	$121.15	$121.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $264.66 / $407.43 / $902.11	Professional		$264.66	$407.43	$902.11
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.14 / $43.86 / $149.09	Professional	26	$38.14	$43.86	$149.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $206.24 / $315.95 / $788.78	Professional	TC	$206.24	$315.95	$788.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $121.15 / $124.68 / $204.42	Facility	26	$121.15	$124.68	$204.42
Midlands Facility/Professional Professional Modifier Low / Median / High Price $382.00 / $631.92 / $793.46	Professional		$382.00	$631.92	$793.46
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $36.90 / $268.30 / $478.92	Professional		$36.90	$268.30	$478.92
United Facility/Professional Professional Modifier Low / Median / High Price $264.66 / $359.81 / $687.22	Professional		$264.66	$359.81	$687.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.14 / $42.59 / $73.61	Professional	26	$38.14	$42.59	$73.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $227.98 / $302.20 / $560.07	Professional	TC	$227.98	$302.20	$560.07
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $400.53 / $507.00 / $596.50	Professional		$400.53	$507.00	$596.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $62.80 / $73.90	Professional	26	$49.61	$62.80	$73.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $350.92 / $444.20 / $522.60	Professional	TC	$350.92	$444.20	$522.60