Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.41 / $186.14 / $289.26	Facility	26	$82.41	$186.14	$289.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.64 / $159.09 / $201.25	Professional		$109.64	$159.09	$201.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.33 / $65.29 / $89.06	Professional	26	$56.33	$65.29	$89.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.00 / $76.68 / $131.93	Professional	TC	$53.00	$76.68	$131.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $150.38 / $293.05 / $477.80	Professional		$150.38	$293.05	$477.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.54 / $147.72 / $223.21	Professional	26	$63.54	$147.72	$223.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.12 / $151.96 / $280.50	Professional	TC	$87.12	$151.96	$280.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $106.14 / $175.17 / $625.46	Professional		$106.14	$175.17	$625.46
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $90.59 / $324.18	Professional	26	$54.95	$90.59	$324.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.37 / $86.85 / $331.84	Professional	TC	$49.37	$86.85	$331.84
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $352.88 / $352.88 / $352.88	Facility	26	$352.88	$352.88	$352.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $151.33 / $274.80 / $1,060.27	Professional		$151.33	$274.80	$1,060.27
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.69 / $125.96 / $369.36	Professional	26	$67.69	$125.96	$369.36
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.17 / $135.80 / $707.89	Professional	TC	$64.17	$135.80	$707.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $180.68 / $274.80 / $354.48	Professional		$180.68	$274.80	$354.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $153.69 / $153.69 / $478.70	Professional		$153.69	$153.69	$478.70
United Facility/Professional Professional Modifier Low / Median / High Price $128.05 / $223.81 / $349.23	Professional		$128.05	$223.81	$349.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.16 / $103.73 / $164.86	Professional	26	$63.16	$103.73	$164.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.71 / $119.40 / $167.09	Professional	TC	$61.71	$119.40	$167.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $170.40 / $215.70 / $253.80	Professional		$170.40	$215.70	$253.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $85.72 / $108.50 / $127.60	Professional	26	$85.72	$108.50	$127.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $84.69 / $107.20 / $126.20	Professional	TC	$84.69	$107.20	$126.20