Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.31 / $162.08 / $261.89	Facility	26	$85.31	$162.08	$261.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $215.53 / $262.72 / $976.51	Professional		$215.53	$262.72	$976.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.09 / $85.31 / $335.70	Professional	26	$59.09	$85.31	$335.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.75 / $168.03 / $293.50	Professional	TC	$152.75	$168.03	$293.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $264.51 / $514.14 / $759.42	Professional		$264.51	$514.14	$759.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.34 / $151.69 / $233.48	Professional	26	$79.34	$151.69	$233.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $185.16 / $334.37 / $525.91	Professional	TC	$185.16	$334.37	$525.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $188.23 / $295.11 / $991.78	Professional		$188.23	$295.11	$991.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.28 / $92.78 / $254.59	Professional	26	$56.28	$92.78	$254.59
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.94 / $206.45 / $600.37	Professional	TC	$131.94	$206.45	$600.37
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $314.00 / $314.00 / $314.00	Facility	26	$314.00	$314.00	$314.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $240.38 / $458.91 / $1,442.20	Professional		$240.38	$458.91	$1,442.20
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.84 / $113.40 / $507.29	Professional	26	$66.84	$113.40	$507.29
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $171.37 / $265.02 / $1,055.58	Professional	TC	$171.37	$265.02	$1,055.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $347.06 / $472.01 / $612.51	Professional		$347.06	$472.01	$612.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.17 / $196.94 / $379.74	Professional		$60.17	$196.94	$379.74
United Facility/Professional Professional Modifier Low / Median / High Price $237.47 / $316.87 / $620.62	Professional		$237.47	$316.87	$620.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.31 / $93.22 / $178.18	Professional	26	$65.31	$93.22	$178.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $171.37 / $229.15 / $485.77	Professional	TC	$171.37	$229.15	$485.77
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $340.02 / $430.40 / $506.30	Professional		$340.02	$430.40	$506.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $94.88 / $120.10 / $141.30	Professional	26	$94.88	$120.10	$141.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $245.14 / $310.30 / $365.00	Professional	TC	$245.14	$310.30	$365.00