Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.56 / $217.66 / $351.70	Facility	26	$114.56	$217.66	$351.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $237.21 / $302.23 / $1,108.16	Professional		$237.21	$302.23	$1,108.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.59 / $97.12 / $366.33	Professional	26	$79.59	$97.12	$366.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.07 / $174.58 / $255.40	Professional	TC	$144.07	$174.58	$255.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.98 / $540.70 / $946.07	Professional		$308.98	$540.70	$946.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.03 / $203.71 / $323.07	Professional	26	$115.03	$203.71	$323.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $182.50 / $351.77 / $478.94	Professional	TC	$182.50	$351.77	$478.94
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $202.24 / $303.50 / $882.15	Professional		$202.24	$303.50	$882.15
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.67 / $111.84 / $321.02	Professional	26	$75.67	$111.84	$321.02
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $126.57 / $193.53 / $641.82	Professional	TC	$126.57	$193.53	$641.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $366.35 / $366.35 / $366.35	Facility	26	$366.35	$366.35	$366.35
Medica Facility/Professional Professional Modifier Low / Median / High Price $243.46 / $466.00 / $2,380.40	Professional		$243.46	$466.00	$2,380.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $88.25 / $151.90 / $520.19	Professional	26	$88.25	$151.90	$520.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $151.93 / $239.87 / $982.86	Professional	TC	$151.93	$239.87	$982.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $362.08 / $530.65 / $634.75	Professional		$362.08	$530.65	$634.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $80.78 / $211.46 / $407.53	Professional		$80.78	$211.46	$407.53
United Facility/Professional Professional Modifier Low / Median / High Price $239.27 / $334.18 / $628.57	Professional		$239.27	$334.18	$628.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.34 / $126.78 / $238.67	Professional	26	$87.34	$126.78	$238.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.02 / $199.07 / $389.90	Professional	TC	$151.02	$199.07	$389.90
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $362.69 / $459.10 / $540.10	Professional		$362.69	$459.10	$540.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $127.59 / $161.50 / $190.00	Professional	26	$127.59	$161.50	$190.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $235.10 / $297.60 / $350.10	Professional	TC	$235.10	$297.60	$350.10