Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.58 / $74.41 / $114.36	Facility	26	$32.58	$74.41	$114.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.32 / $210.96 / $363.87	Professional		$145.32	$210.96	$363.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.06 / $25.76 / $53.71	Professional	26	$22.06	$25.76	$53.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.19 / $178.38 / $299.55	Professional	TC	$123.19	$178.38	$299.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.18 / $382.64 / $654.76	Professional		$176.18	$382.64	$654.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.40 / $57.20 / $91.20	Professional	26	$25.40	$57.20	$91.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $150.46 / $325.45 / $563.55	Professional	TC	$150.46	$325.45	$563.55
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $141.10 / $219.73 / $572.58	Professional		$141.10	$219.73	$572.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.91 / $36.77 / $123.57	Professional	26	$21.91	$36.77	$123.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.49 / $186.79 / $478.96	Professional	TC	$115.49	$186.79	$478.96
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $236.27 / $236.27 / $236.27	Facility	26	$236.27	$236.27	$236.27
Medica Facility/Professional Professional Modifier Low / Median / High Price $194.16 / $347.37 / $1,431.47	Professional		$194.16	$347.37	$1,431.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.28 / $49.81 / $293.89	Professional	26	$27.28	$49.81	$293.89
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $147.16 / $288.56 / $1,288.22	Professional	TC	$147.16	$288.56	$1,288.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $220.00 / $360.40 / $437.15	Professional		$220.00	$360.40	$437.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.45 / $156.71 / $279.73	Professional		$26.45	$156.71	$279.73
United Facility/Professional Professional Modifier Low / Median / High Price $166.86 / $290.93 / $433.83	Professional		$166.86	$290.93	$433.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.98 / $37.95 / $64.52	Professional	26	$25.98	$37.95	$64.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.47 / $238.02 / $365.99	Professional	TC	$141.47	$238.02	$365.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $232.26 / $294.00 / $345.80	Professional		$232.26	$294.00	$345.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $34.04 / $43.10 / $50.80	Professional	26	$34.04	$43.10	$50.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $198.13 / $250.80 / $295.10	Professional	TC	$198.13	$250.80	$295.10