Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.63 / $198.73 / $221.57	Professional		$170.63	$198.73	$221.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.57 / $104.72 / $116.75	Professional	26	$91.57	$104.72	$116.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.06 / $94.01 / $104.82	Professional	TC	$79.06	$94.01	$104.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.92 / $421.85 / $673.68	Professional		$166.92	$421.85	$673.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $121.12 / $232.61 / $414.44	Professional	26	$121.12	$232.61	$414.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.14 / $213.31 / $313.25	Professional	TC	$46.14	$213.31	$313.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.55 / $378.14 / $505.36	Professional		$199.55	$378.14	$505.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $98.33 / $200.31 / $425.21	Professional	26	$98.33	$200.31	$425.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.30 / $168.93 / $262.62	Professional	TC	$59.30	$168.93	$262.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $579.90 / $579.90 / $579.90	Facility	26	$579.90	$579.90	$579.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $225.66 / $430.10 / $1,548.81	Professional		$225.66	$430.10	$1,548.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $129.62 / $200.84 / $832.85	Professional	26	$129.62	$200.84	$832.85
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $95.69 / $155.78 / $785.37	Professional	TC	$95.69	$155.78	$785.37
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $340.85 / $340.85 / $340.85	Facility	26	$340.85	$340.85	$340.85
Midlands Facility/Professional Professional Modifier Low / Median / High Price $277.14 / $412.82 / $595.69	Professional		$277.14	$412.82	$595.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $110.92 / $204.15 / $400.42	Professional		$110.92	$204.15	$400.42
United Facility/Professional Professional Modifier Low / Median / High Price $225.40 / $225.66 / $547.32	Professional		$225.40	$225.66	$547.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $129.62 / $133.87 / $304.26	Professional	26	$129.62	$133.87	$304.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.69 / $98.56 / $232.09	Professional	TC	$95.69	$98.56	$232.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $401.70 / $472.60 / $555.79	Professional		$401.70	$472.60	$555.79
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $200.30 / $235.60 / $277.10	Professional	26	$200.30	$235.60	$277.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $201.40 / $237.00 / $278.70	Professional	TC	$201.40	$237.00	$278.70