Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.96 / $98.36 / $158.93	Facility	26	$88.96	$98.36	$158.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.95 / $204.37 / $532.13	Professional		$182.95	$204.37	$532.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $37.94 / $132.59	Professional	26	$23.61	$37.94	$132.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $146.09 / $169.96 / $280.87	Professional	TC	$146.09	$169.96	$280.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.08 / $450.76 / $800.49	Professional		$204.08	$450.76	$800.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $75.37 / $97.87	Professional	26	$28.99	$75.37	$97.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $176.59 / $372.25 / $661.57	Professional	TC	$176.59	$372.25	$661.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $170.68 / $288.37 / $612.45	Professional		$170.68	$288.37	$612.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.04 / $44.76 / $109.11	Professional	26	$35.04	$44.76	$109.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $135.65 / $231.22 / $494.07	Professional	TC	$135.65	$231.22	$494.07
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $169.56 / $169.56 / $169.56	Facility	26	$169.56	$169.56	$169.56
Medica Facility/Professional Professional Modifier Low / Median / High Price $238.84 / $406.65 / $1,546.49	Professional		$238.84	$406.65	$1,546.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.25 / $69.00 / $391.31	Professional	26	$34.25	$69.00	$391.31
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $176.15 / $329.91 / $1,417.87	Professional	TC	$176.15	$329.91	$1,417.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $302.57 / $389.72 / $507.58	Professional		$302.57	$389.72	$507.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $182.33 / $351.24	Professional		$38.90	$182.33	$351.24
United Facility/Professional Professional Modifier Low / Median / High Price $210.76 / $347.92 / $574.79	Professional		$210.76	$347.92	$574.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.39 / $61.49 / $101.71	Professional	26	$35.39	$61.49	$101.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.26 / $286.29 / $416.62	Professional	TC	$169.26	$286.29	$416.62
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $287.24 / $363.60 / $427.80	Professional		$287.24	$363.60	$427.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $54.51 / $69.00 / $81.20	Professional	26	$54.51	$69.00	$81.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $232.73 / $294.60 / $346.60	Professional	TC	$232.73	$294.60	$346.60