Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.12 / $146.36 / $270.74	Facility	26	$97.12	$146.36	$270.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.28 / $184.28 / $1,538.52	Professional		$184.28	$184.28	$1,538.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.90 / $43.78 / $279.08	Professional	26	$40.90	$43.78	$279.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $143.38 / $143.38 / $1,259.44	Professional	TC	$143.38	$143.38	$1,259.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $144.78 / $149.12 / $153.47	Facility	26	$144.78	$149.12	$153.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $440.48 / $485.59 / $606.99	Professional		$440.48	$485.59	$606.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.07 / $103.17 / $128.96	Professional	26	$96.07	$103.17	$128.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $344.43 / $382.42 / $478.03	Professional	TC	$344.43	$382.42	$478.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $179.59 / $311.27 / $705.69	Professional		$179.59	$311.27	$705.69
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $69.37 / $133.47	Professional	26	$42.24	$69.37	$133.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $137.35 / $245.47 / $572.21	Professional	TC	$137.35	$245.47	$572.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $149.12 / $149.12 / $149.12	Facility	26	$149.12	$149.12	$149.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $225.93 / $352.15 / $922.36	Professional		$225.93	$352.15	$922.36
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $47.26 / $54.47 / $193.21	Professional	26	$47.26	$54.47	$193.21
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $167.73 / $201.28 / $885.37	Professional	TC	$167.73	$201.28	$885.37
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $149.12 / $153.47 / $254.40	Facility	26	$149.12	$153.47	$254.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $392.47 / $474.00 / $660.05	Professional		$392.47	$474.00	$660.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.20 / $191.13 / $434.94	Professional		$45.20	$191.13	$434.94
United Facility/Professional Professional Modifier Low / Median / High Price $214.99 / $247.24 / $431.27	Professional		$214.99	$247.24	$431.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.19 / $54.35 / $96.27	Professional	26	$47.19	$54.35	$96.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $167.73 / $200.86 / $347.02	Professional	TC	$167.73	$200.86	$347.02
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $279.19 / $353.40 / $415.80	Professional		$279.19	$353.40	$415.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $60.91 / $77.09 / $90.70	Professional	26	$60.91	$77.09	$90.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $218.28 / $276.30 / $325.10	Professional	TC	$218.28	$276.30	$325.10