Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.42 / $155.00 / $219.17	Professional		$115.42	$155.00	$219.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.51 / $52.28 / $80.95	Professional	26	$40.51	$52.28	$80.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.83 / $105.74 / $198.35	Professional	TC	$74.83	$105.74	$198.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.00 / $296.86 / $386.51	Professional		$190.00	$296.86	$386.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.03 / $102.27 / $138.51	Professional	26	$79.03	$102.27	$138.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $194.59 / $248.22	Professional	TC	$119.70	$194.59	$248.22
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $103.78 / $161.19 / $458.98	Professional		$103.78	$161.19	$458.98
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.79 / $64.31 / $167.62	Professional	26	$40.79	$64.31	$167.62
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.99 / $95.91 / $291.36	Professional	TC	$62.99	$95.91	$291.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $149.24 / $295.12 / $944.58	Professional		$149.24	$295.12	$944.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.31 / $105.16 / $386.24	Professional	26	$58.31	$105.16	$386.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $85.40 / $185.42 / $782.04	Professional	TC	$85.40	$185.42	$782.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $190.00 / $288.23 / $373.31	Professional		$190.00	$288.23	$373.31
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $44.17 / $113.80 / $210.54	Professional		$44.17	$113.80	$210.54
United Facility/Professional Professional Modifier Low / Median / High Price $133.22 / $241.76 / $329.44	Professional		$133.22	$241.76	$329.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.79 / $94.56 / $139.59	Professional	26	$51.79	$94.56	$139.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.29 / $157.30 / $206.96	Professional	TC	$83.29	$157.30	$206.96
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $186.05 / $235.50 / $277.10	Professional		$186.05	$235.50	$277.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $69.05 / $87.40 / $102.80	Professional	26	$69.05	$87.40	$102.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $117.00 / $148.10 / $174.30	Professional	TC	$117.00	$148.10	$174.30