Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.47 / $89.47 / $89.47	Facility	26	$89.47	$89.47	$89.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.19 / $333.44 / $710.82	Professional		$216.19	$333.44	$710.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.09 / $53.90 / $96.87	Professional	26	$47.09	$53.90	$96.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $156.60 / $279.54 / $613.94	Professional	TC	$156.60	$279.54	$613.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.87 / $515.57 / $903.18	Professional		$186.87	$515.57	$903.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.33 / $119.38 / $162.85	Professional	26	$49.33	$119.38	$162.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $145.26 / $524.20 / $740.33	Professional	TC	$145.26	$524.20	$740.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $295.52 / $606.91 / $900.55	Professional		$295.52	$606.91	$900.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.41 / $103.29 / $252.13	Professional	26	$50.41	$103.29	$252.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.12 / $435.98 / $648.41	Professional	TC	$245.12	$435.98	$648.41
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $283.08 / $283.08 / $283.08	Facility	26	$283.08	$283.08	$283.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $204.63 / $515.57 / $2,575.76	Professional		$204.63	$515.57	$2,575.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $65.06 / $67.53 / $393.91	Professional	26	$65.06	$67.53	$393.91
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $137.21 / $321.29 / $2,181.85	Professional	TC	$137.21	$321.29	$2,181.85
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $220.05 / $220.05 / $220.05	Facility	26	$220.05	$220.05	$220.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $429.83 / $668.57 / $902.52	Professional		$429.83	$668.57	$902.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.62 / $350.18 / $639.91	Professional		$61.62	$350.18	$639.91
United Facility/Professional Professional Modifier Low / Median / High Price $377.49 / $388.81 / $754.98	Professional		$377.49	$388.81	$754.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.48 / $67.53 / $153.47	Professional	26	$65.48	$67.53	$153.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $311.93 / $321.27 / $645.55	Professional	TC	$311.93	$321.27	$645.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $659.90 / $776.30 / $913.00	Professional		$659.90	$776.30	$913.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $106.10 / $124.80 / $146.80	Professional	26	$106.10	$124.80	$146.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $553.79 / $651.50 / $766.20	Professional	TC	$553.79	$651.50	$766.20