Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.86 / $59.86 / $59.86	Facility	26	$59.86	$59.86	$59.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $209.50 / $255.03 / $500.04	Professional		$209.50	$255.03	$500.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.51 / $36.11 / $62.16	Professional	26	$31.51	$36.11	$62.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.31 / $218.92 / $437.87	Professional	TC	$168.31	$218.92	$437.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.66 / $411.14 / $757.10	Professional		$159.66	$411.14	$757.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.08 / $71.39 / $111.95	Professional	26	$34.08	$71.39	$111.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.37 / $405.23 / $645.15	Professional	TC	$134.37	$405.23	$645.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $207.50 / $426.04 / $774.24	Professional		$207.50	$426.04	$774.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.72 / $57.44 / $153.84	Professional	26	$32.72	$57.44	$153.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $174.78 / $310.94 / $620.40	Professional	TC	$174.78	$310.94	$620.40
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $183.18 / $183.18 / $183.18	Facility	26	$183.18	$183.18	$183.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $193.68 / $411.14 / $2,077.04	Professional		$193.68	$411.14	$2,077.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.73 / $46.20 / $267.88	Professional	26	$44.73	$46.20	$267.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $147.47 / $302.07 / $1,809.15	Professional	TC	$147.47	$302.07	$1,809.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $151.50 / $151.50 / $151.50	Facility	26	$151.50	$151.50	$151.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $315.24 / $509.70 / $735.85	Professional		$315.24	$509.70	$735.85
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.95 / $245.82 / $448.94	Professional		$39.95	$245.82	$448.94
United Facility/Professional Professional Modifier Low / Median / High Price $318.64 / $328.21 / $660.19	Professional		$318.64	$328.21	$660.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.82 / $46.19 / $104.99	Professional	26	$44.82	$46.19	$104.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $273.80 / $282.01 / $547.60	Professional	TC	$273.80	$282.01	$547.60
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $463.50 / $545.29 / $641.29	Professional		$463.50	$545.29	$641.29
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $68.70 / $80.80 / $95.00	Professional	26	$68.70	$80.80	$95.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $394.90 / $464.60 / $546.40	Professional	TC	$394.90	$464.60	$546.40