Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.97 / $103.03 / $211.93	Facility	26	$69.97	$103.03	$211.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.99 / $163.06 / $352.58	Professional		$130.99	$163.06	$352.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.14 / $49.82 / $87.73	Professional	26	$41.14	$49.82	$87.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.49 / $113.14 / $173.76	Professional	TC	$88.49	$113.14	$173.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.05 / $300.18 / $558.11	Professional		$190.05	$300.18	$558.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.87 / $106.97 / $166.79	Professional	26	$56.87	$106.97	$166.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.03 / $201.84 / $385.23	Professional	TC	$134.03	$201.84	$385.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $121.46 / $202.73 / $538.33	Professional		$121.46	$202.73	$538.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.01 / $65.92 / $175.53	Professional	26	$40.01	$65.92	$175.53
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.59 / $138.44 / $397.02	Professional	TC	$78.59	$138.44	$397.02
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $214.35 / $214.35 / $214.35	Facility	26	$214.35	$214.35	$214.35
Medica Facility/Professional Professional Modifier Low / Median / High Price $150.09 / $282.91 / $1,086.26	Professional		$150.09	$282.91	$1,086.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $48.50 / $80.36 / $449.09	Professional	26	$48.50	$80.36	$449.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $97.81 / $185.42 / $867.64	Professional	TC	$97.81	$185.42	$867.64
Midlands Facility/Professional Professional Modifier Low / Median / High Price $191.40 / $272.97 / $383.41	Professional		$191.40	$272.97	$383.41
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.85 / $124.10 / $239.19	Professional		$42.85	$124.10	$239.19
United Facility/Professional Professional Modifier Low / Median / High Price $144.00 / $234.16 / $377.21	Professional		$144.00	$234.16	$377.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.19 / $66.69 / $126.27	Professional	26	$46.19	$66.69	$126.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.19 / $152.81 / $250.94	Professional	TC	$97.19	$152.81	$250.94
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $213.46 / $270.20 / $317.89	Professional		$213.46	$270.20	$317.89
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $67.47 / $85.40 / $100.50	Professional	26	$67.47	$85.40	$100.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $145.99 / $184.80 / $217.40	Professional	TC	$145.99	$184.80	$217.40