Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $102.33 / $588.84	Facility		$77.62	$102.33	$588.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Facility	26	$53.70	$53.70	$53.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $48.98 / $117.49 / $977.24	Facility	TC	$48.98	$117.49	$977.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $229.09 / $977.24	Professional		$64.57	$229.09	$977.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $102.33 / $831.76	Professional	26	$33.88	$102.33	$831.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $74.13 / $537.03	Professional	TC	$26.92	$74.13	$537.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $138.04 / $229.09	Professional		$72.44	$138.04	$229.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $69.18 / $114.82	Professional	26	$30.20	$69.18	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $67.61 / $125.89	Professional	TC	$40.74	$67.61	$125.89
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $114.82 / $239.88	Professional		$81.28	$114.82	$239.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $194.98	Professional	26	$46.77	$58.88	$194.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.96 / $47.86 / $104.71	Professional	TC	$10.96	$47.86	$104.71
Medica Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $147.91 / $269.15	Facility		$79.43	$147.91	$269.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	26	$162.18	$162.18	$162.18
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	TC	$213.80	$213.80	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $128.82 / $549.54	Professional		$67.61	$128.82	$549.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $75.86 / $295.12	Professional	26	$38.02	$75.86	$295.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $61.66 / $346.74	Professional	TC	$28.84	$61.66	$346.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $138.04 / $204.17	Professional		$83.18	$138.04	$204.17
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $69.18 / $144.54	Professional	26	$42.66	$69.18	$144.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $67.61 / $125.89	Professional	TC	$40.74	$67.61	$125.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $199.53	Professional		$131.83	$131.83	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $75.86 / $75.86	Professional	26	$74.13	$75.86	$75.86
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $125.89	Professional	TC	$54.95	$54.95	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $66.07 / $131.83	Professional		$34.67	$66.07	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $70.79 / $190.55	Professional		$67.61	$70.79	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.90 / $107.15	Professional	26	$38.02	$38.90	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $32.36 / $83.18	Professional	TC	$28.84	$32.36	$83.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $144.54 / $169.82	Professional		$123.03	$144.54	$169.82
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $72.44 / $85.11	Professional	26	$61.66	$72.44	$85.11
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $70.79 / $83.18	Professional	TC	$60.26	$70.79	$83.18