Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $118.21 / $136.22 / $408.67	Facility		$118.21	$136.22	$408.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.25 / $39.25 / $39.25	Facility	26	$39.25	$39.25	$39.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.59 / $193.44 / $587.47	Facility	TC	$40.59	$193.44	$587.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.22 / $72.92 / $371.58	Professional		$62.22	$72.92	$371.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.66 / $29.49 / $161.04	Professional	26	$20.66	$29.49	$161.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.55 / $49.12 / $124.84	Professional	TC	$41.55	$49.12	$124.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.82 / $135.85 / $220.99	Professional		$52.82	$135.85	$220.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.64 / $47.74 / $72.08	Professional	26	$16.64	$47.74	$72.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.17 / $107.62 / $150.13	Professional	TC	$36.17	$107.62	$150.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $73.95 / $151.87 / $262.58	Professional		$73.95	$151.87	$262.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.05 / $44.87 / $90.62	Professional	26	$22.05	$44.87	$90.62
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.91 / $92.60 / $190.51	Professional	TC	$51.91	$92.60	$190.51
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.03 / $117.46 / $437.49	Facility		$77.03	$117.46	$437.49
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $124.11 / $124.11 / $124.11	Facility	26	$124.11	$124.11	$124.11
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $313.37 / $313.37 / $313.37	Facility	TC	$313.37	$313.37	$313.37
Medica Facility/Professional Professional Modifier Low / Median / High Price $64.37 / $141.29 / $559.76	Professional		$64.37	$141.29	$559.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.55 / $47.42 / $173.52	Professional	26	$28.55	$47.42	$173.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $42.22 / $64.59 / $386.24	Professional	TC	$42.22	$64.59	$386.24
Midlands Facility/Professional Facility Modifier Low / Median / High Price $106.84 / $164.78 / $173.48	Facility		$106.84	$164.78	$173.48
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $53.19 / $53.19 / $53.19	Facility	26	$53.19	$53.19	$53.19
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $111.59 / $111.59 / $111.59	Facility	TC	$111.59	$111.59	$111.59
Midlands Facility/Professional Professional Modifier Low / Median / High Price $106.84 / $160.50 / $220.99	Professional		$106.84	$160.50	$220.99
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.99 / $87.81 / $159.99	Professional		$29.99	$87.81	$159.99
United Facility/Professional Professional Modifier Low / Median / High Price $87.14 / $89.75 / $190.40	Professional		$87.14	$89.75	$190.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $29.41 / $71.59	Professional	26	$28.51	$29.41	$71.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.59 / $60.34 / $127.55	Professional	TC	$58.59	$60.34	$127.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $164.00 / $192.90 / $226.90	Professional		$164.00	$192.90	$226.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $54.70 / $64.40	Professional	26	$46.50	$54.70	$64.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $117.40 / $138.19 / $162.50	Professional	TC	$117.40	$138.19	$162.50