Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.38 / $76.88 / $120.67	Facility	26	$34.38	$76.88	$120.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.65 / $126.61 / $175.21	Professional		$101.65	$126.61	$175.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.50 / $30.91 / $45.47	Professional	26	$23.50	$30.91	$45.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.04 / $101.94 / $140.84	Professional	TC	$69.04	$101.94	$140.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.14 / $341.27 / $665.65	Professional		$164.14	$341.27	$665.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.61 / $72.58 / $115.49	Professional	26	$31.61	$72.58	$115.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.38 / $268.69 / $524.08	Professional	TC	$135.38	$268.69	$524.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $143.81 / $234.00 / $456.36	Professional		$143.81	$234.00	$456.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.02 / $50.50 / $71.00	Professional	26	$33.02	$50.50	$71.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $106.97 / $167.28 / $380.50	Professional	TC	$106.97	$167.28	$380.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $160.47 / $160.47 / $160.47	Facility	26	$160.47	$160.47	$160.47
Medica Facility/Professional Professional Modifier Low / Median / High Price $188.00 / $303.75 / $1,341.64	Professional		$188.00	$303.75	$1,341.64
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $29.17 / $53.26 / $375.24	Professional	26	$29.17	$53.26	$375.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $144.13 / $263.20 / $1,090.58	Professional	TC	$144.13	$263.20	$1,090.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $195.89 / $257.30 / $386.32	Professional		$195.89	$257.30	$386.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.56 / $158.88 / $286.29	Professional		$37.56	$158.88	$286.29
United Facility/Professional Professional Modifier Low / Median / High Price $165.65 / $279.54 / $431.00	Professional		$165.65	$279.54	$431.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.07 / $41.58 / $68.98	Professional	26	$27.07	$41.58	$68.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.58 / $245.61 / $358.47	Professional	TC	$138.58	$245.61	$358.47
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $235.10 / $297.60 / $350.20	Professional		$235.10	$297.60	$350.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $51.59 / $65.30 / $76.90	Professional	26	$51.59	$65.30	$76.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $183.52 / $232.30 / $273.30	Professional	TC	$183.52	$232.30	$273.30