Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.40 / $181.27 / $292.91	Facility	26	$95.40	$181.27	$292.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.86 / $233.55 / $942.49	Professional		$183.86	$233.55	$942.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.00 / $88.55 / $346.00	Professional	26	$67.00	$88.55	$346.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $114.34 / $148.83 / $242.36	Professional	TC	$114.34	$148.83	$242.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.30 / $437.12 / $521.13	Professional		$195.30	$437.12	$521.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.45 / $170.03 / $269.39	Professional	26	$89.45	$170.03	$269.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.90 / $250.71 / $337.45	Professional	TC	$117.90	$250.71	$337.45
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $161.05 / $241.32 / $650.36	Professional		$161.05	$241.32	$650.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.17 / $104.23 / $251.43	Professional	26	$63.17	$104.23	$251.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $97.89 / $149.25 / $422.91	Professional	TC	$97.89	$149.25	$422.91
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $557.91 / $557.91 / $557.91	Facility	26	$557.91	$557.91	$557.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $197.04 / $377.90 / $1,677.02	Professional		$197.04	$377.90	$1,677.02
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $76.55 / $129.25 / $718.23	Professional	26	$76.55	$129.25	$718.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $119.87 / $218.73 / $985.97	Professional	TC	$119.87	$218.73	$985.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $281.45 / $412.08 / $513.13	Professional		$281.45	$412.08	$513.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $67.37 / $167.98 / $324.04	Professional		$67.37	$167.98	$324.04
United Facility/Professional Professional Modifier Low / Median / High Price $191.91 / $268.70 / $509.02	Professional		$191.91	$268.70	$509.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.90 / $101.72 / $199.23	Professional	26	$72.90	$101.72	$199.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.51 / $169.56 / $321.77	Professional	TC	$114.51	$169.56	$321.77
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $288.35 / $365.00 / $429.40	Professional		$288.35	$365.00	$429.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $106.49 / $134.80 / $158.60	Professional	26	$106.49	$134.80	$158.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $181.86 / $230.20 / $270.80	Professional	TC	$181.86	$230.20	$270.80