Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $164.21 / $174.24 / $221.80	Facility		$164.21	$174.24	$221.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.31 / $97.31 / $97.31	Facility	26	$97.31	$97.31	$97.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.74 / $136.94 / $301.02	Professional		$116.74	$136.94	$301.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.22 / $65.70 / $265.45	Professional	26	$51.22	$65.70	$265.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.52 / $78.01 / $194.98	Professional	TC	$65.52	$78.01	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.49 / $240.00 / $411.94	Professional		$91.49	$240.00	$411.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.54 / $126.00 / $189.01	Professional	26	$56.54	$126.00	$189.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.64 / $130.51 / $201.39	Professional	TC	$38.64	$130.51	$201.39
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $102.58 / $224.35 / $334.66	Professional		$102.58	$224.35	$334.66
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.56 / $110.72 / $217.36	Professional	26	$69.56	$110.72	$217.36
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.39 / $120.60 / $194.56	Professional	TC	$19.39	$120.60	$194.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $137.00 / $206.25 / $398.08	Facility		$137.00	$206.25	$398.08
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $305.79 / $305.79 / $305.79	Facility	26	$305.79	$305.79	$305.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $146.46 / $251.76 / $1,961.76	Professional		$146.46	$251.76	$1,961.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $71.13 / $134.54 / $434.05	Professional	26	$71.13	$134.54	$434.05
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $75.06 / $122.52 / $557.54	Professional	TC	$75.06	$122.52	$557.54
Midlands Facility/Professional Facility Modifier Low / Median / High Price $181.38 / $257.60 / $349.64	Facility		$181.38	$257.60	$349.64
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $181.03 / $181.03 / $181.03	Facility	26	$181.03	$181.03	$181.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $189.48 / $266.08 / $349.64	Professional		$189.48	$266.08	$349.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.95 / $156.50 / $287.80	Professional		$66.95	$156.50	$287.80
United Facility/Professional Professional Modifier Low / Median / High Price $146.46 / $150.91 / $342.98	Professional		$146.46	$150.91	$342.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.13 / $71.25 / $166.80	Professional	26	$71.13	$71.25	$166.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.26 / $77.52 / $176.18	Professional	TC	$75.26	$77.52	$176.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $291.60 / $343.10 / $403.50	Professional		$291.60	$343.10	$403.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $114.60 / $134.80 / $158.60	Professional	26	$114.60	$134.80	$158.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $177.00 / $208.30 / $244.90	Professional	TC	$177.00	$208.30	$244.90