Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.24 / $108.24 / $141.30	Facility		$108.24	$108.24	$141.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.05 / $86.05 / $86.05	Facility	26	$86.05	$86.05	$86.05
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $55.25 / $97.91 / $317.20	Facility	TC	$55.25	$97.91	$317.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.37 / $87.44 / $230.01	Professional		$74.37	$87.44	$230.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.29 / $58.20 / $228.41	Professional	26	$45.29	$58.20	$228.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.08 / $34.52 / $76.47	Professional	TC	$29.08	$34.52	$76.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.70 / $170.88 / $259.41	Professional		$63.70	$170.88	$259.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $108.00 / $157.40	Professional	26	$48.54	$108.00	$157.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.83 / $54.32 / $80.80	Professional	TC	$15.83	$54.32	$80.80
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $99.40 / $145.37 / $222.93	Professional		$99.40	$145.37	$222.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.80 / $98.37 / $169.91	Professional	26	$60.80	$98.37	$169.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.42 / $50.60 / $86.93	Professional	TC	$25.42	$50.60	$86.93
Medica Facility/Professional Facility Modifier Low / Median / High Price $114.53 / $150.72 / $304.01	Facility		$114.53	$150.72	$304.01
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $272.47 / $272.47 / $272.47	Facility	26	$272.47	$272.47	$272.47
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $184.67 / $184.67 / $184.67	Facility	TC	$184.67	$184.67	$184.67
Medica Facility/Professional Professional Modifier Low / Median / High Price $93.73 / $160.53 / $643.49	Professional		$93.73	$160.53	$643.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.11 / $97.98 / $383.71	Professional	26	$60.11	$97.98	$383.71
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $29.86 / $51.41 / $350.03	Professional	TC	$29.86	$51.41	$350.03
Midlands Facility/Professional Facility Modifier Low / Median / High Price $115.98 / $171.88 / $226.77	Facility		$115.98	$171.88	$226.77
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $157.63 / $157.63 / $157.63	Facility	26	$157.63	$157.63	$157.63
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $89.38 / $89.38 / $89.38	Facility	TC	$89.38	$89.38	$89.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $118.12 / $171.88 / $226.77	Professional		$118.12	$171.88	$226.77
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.69 / $92.76 / $170.90	Professional		$40.69	$92.76	$170.90
United Facility/Professional Professional Modifier Low / Median / High Price $93.73 / $97.30 / $229.13	Professional		$93.73	$97.30	$229.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.83 / $64.78 / $147.22	Professional	26	$62.83	$64.78	$147.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.58 / $32.52 / $87.04	Professional	TC	$31.58	$32.52	$87.04
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $171.30 / $201.60 / $237.10	Professional		$171.30	$201.60	$237.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $102.10 / $120.20 / $141.30	Professional	26	$102.10	$120.20	$141.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $69.20 / $81.40 / $95.80	Professional	TC	$69.20	$81.40	$95.80