Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $274.11 / $274.11 / $274.11	Facility	26	$274.11	$274.11	$274.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.61 / $240.18 / $772.00	Professional		$164.61	$240.18	$772.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.18 / $124.32 / $641.52	Professional	26	$96.18	$124.32	$641.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.43 / $87.67 / $182.21	Professional	TC	$68.43	$87.67	$182.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.49 / $400.16 / $569.69	Professional		$308.49	$400.16	$569.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $177.76 / $231.46 / $335.69	Professional	26	$177.76	$231.46	$335.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.70 / $174.55 / $234.00	Professional	TC	$123.70	$174.55	$234.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $155.28 / $238.79 / $523.91	Professional		$155.28	$238.79	$523.91
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.70 / $146.87 / $424.31	Professional	26	$95.70	$146.87	$424.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.58 / $93.15 / $481.07	Professional	TC	$59.58	$93.15	$481.07
Medica Facility/Professional Professional Modifier Low / Median / High Price $244.51 / $411.25 / $1,142.65	Professional		$244.51	$411.25	$1,142.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $136.47 / $241.09 / $663.65	Professional	26	$136.47	$241.09	$663.65
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $97.11 / $175.00 / $479.00	Professional	TC	$97.11	$175.00	$479.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $293.04 / $391.10 / $501.80	Professional		$293.04	$391.10	$501.80
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.58 / $161.66 / $311.66	Professional		$72.58	$161.66	$311.66
United Facility/Professional Professional Modifier Low / Median / High Price $209.74 / $383.00 / $580.88	Professional		$209.74	$383.00	$580.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $121.86 / $217.99 / $332.44	Professional	26	$121.86	$217.99	$332.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.06 / $156.65 / $207.86	Professional	TC	$84.06	$156.65	$207.86
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $273.58 / $346.30 / $407.40	Professional		$273.58	$346.30	$407.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $162.90 / $206.20 / $242.60	Professional	26	$162.90	$206.20	$242.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $110.68 / $140.10 / $164.80	Professional	TC	$110.68	$140.10	$164.80