Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.19 / $96.61 / $178.48	Facility	26	$71.19	$96.61	$178.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.05 / $298.33 / $631.78	Professional		$229.05	$298.33	$631.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.86 / $40.32 / $53.98	Professional	26	$34.86	$40.32	$53.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $194.66 / $239.03 / $344.73	Professional	TC	$194.66	$239.03	$344.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $271.35 / $575.91 / $975.42	Professional		$271.35	$575.91	$975.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.15 / $87.44 / $142.93	Professional	26	$40.15	$87.44	$142.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $231.20 / $486.92 / $825.57	Professional	TC	$231.20	$486.92	$825.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $239.46 / $370.79 / $975.34	Professional		$239.46	$370.79	$975.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.08 / $55.62 / $126.50	Professional	26	$37.08	$55.62	$126.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.39 / $277.47 / $704.34	Professional	TC	$202.39	$277.47	$704.34
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $171.05 / $171.05 / $171.05	Facility	26	$171.05	$171.05	$171.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $284.13 / $526.02 / $1,603.44	Professional		$284.13	$526.02	$1,603.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $69.04 / $234.31	Professional	26	$41.69	$69.04	$234.31
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $232.05 / $390.51 / $1,392.98	Professional	TC	$232.05	$390.51	$1,392.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $457.44 / $591.66 / $703.06	Professional		$457.44	$591.66	$703.06
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $331.50 / $331.50 / $331.50	Professional		$331.50	$331.50	$331.50
United Facility/Professional Professional Modifier Low / Median / High Price $271.75 / $407.63 / $672.03	Professional		$271.75	$407.63	$672.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.83 / $63.99 / $100.97	Professional	26	$40.83	$63.99	$100.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $232.05 / $335.92 / $571.05	Professional	TC	$232.05	$335.92	$571.05
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $359.29 / $454.80 / $535.00	Professional		$359.29	$454.80	$535.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $54.98 / $69.59 / $81.90	Professional	26	$54.98	$69.59	$81.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $304.31 / $385.20 / $453.10	Professional	TC	$304.31	$385.20	$453.10