Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $241.09 / $307.44 / $482.18	Facility		$241.09	$307.44	$482.18
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.98 / $113.98 / $113.98	Facility	26	$113.98	$113.98	$113.98
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $206.96 / $325.87 / $867.24	Facility	TC	$206.96	$325.87	$867.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $207.91 / $244.72 / $878.46	Professional		$207.91	$244.72	$878.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.99 / $77.91 / $298.32	Professional	26	$59.99	$77.91	$298.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $175.40 / $391.01	Professional	TC	$147.91	$175.40	$391.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $130.22 / $463.54 / $630.95	Professional		$130.22	$463.54	$630.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.83 / $152.83 / $260.57	Professional	26	$64.83	$152.83	$260.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.12 / $243.48 / $422.42	Professional	TC	$73.12	$243.48	$422.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $142.87 / $363.01 / $475.36	Professional		$142.87	$363.01	$475.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.31 / $129.54 / $401.62	Professional	26	$81.31	$129.54	$401.62
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.02 / $206.49 / $324.14	Professional	TC	$35.02	$206.49	$324.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $215.00 / $350.30 / $728.34	Facility		$215.00	$350.30	$728.34
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $358.77 / $358.77 / $358.77	Facility	26	$358.77	$358.77	$358.77
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $943.11 / $943.11 / $943.11	Facility	TC	$943.11	$943.11	$943.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $251.00 / $422.65 / $1,813.36	Professional		$251.00	$422.65	$1,813.36
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $83.37 / $151.26 / $509.36	Professional	26	$83.37	$151.26	$509.36
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $164.87 / $286.92 / $1,303.99	Professional	TC	$164.87	$286.92	$1,303.99
Midlands Facility/Professional Facility Modifier Low / Median / High Price $311.61 / $473.21 / $627.66	Facility		$311.61	$473.21	$627.66
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $324.00 / $324.00 / $324.00	Facility	26	$324.00	$324.00	$324.00
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $303.68 / $303.68 / $303.68	Facility	TC	$303.68	$303.68	$303.68
Midlands Facility/Professional Professional Modifier Low / Median / High Price $311.61 / $473.21 / $624.73	Professional		$311.61	$473.21	$624.73
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $78.27 / $259.29 / $476.83	Professional		$78.27	$259.29	$476.83
United Facility/Professional Professional Modifier Low / Median / High Price $259.61 / $267.39 / $590.29	Professional		$259.61	$267.39	$590.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $80.18 / $85.87 / $195.17	Professional	26	$80.18	$85.87	$195.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.24 / $181.53 / $412.58	Professional	TC	$176.24	$181.53	$412.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $487.90 / $574.00 / $675.10	Professional		$487.90	$574.00	$675.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $134.50 / $158.19 / $186.00	Professional	26	$134.50	$158.19	$186.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $353.50 / $415.90 / $489.10	Professional	TC	$353.50	$415.90	$489.10