Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $92.31 / $137.10 / $271.39	Facility		$92.31	$137.10	$271.39
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.44 / $48.44 / $264.00	Facility	26	$48.44	$48.44	$264.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $88.63 / $162.43 / $281.42	Facility	TC	$88.63	$162.43	$281.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.16 / $94.35 / $201.28	Professional		$72.16	$94.35	$201.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.50 / $36.83 / $137.80	Professional	26	$25.50	$36.83	$137.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.65 / $60.59 / $142.41	Professional	TC	$46.65	$60.59	$142.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.65 / $184.00 / $302.72	Professional		$61.65	$184.00	$302.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.82 / $65.31 / $115.92	Professional	26	$32.82	$65.31	$115.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.65 / $118.68 / $169.34	Professional	TC	$33.65	$118.68	$169.34
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $67.86 / $151.80 / $218.48	Professional		$67.86	$151.80	$218.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.38 / $55.39 / $124.31	Professional	26	$34.38	$55.39	$124.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.49 / $91.75 / $124.08	Professional	TC	$14.49	$91.75	$124.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $89.51 / $142.52 / $262.04	Facility		$89.51	$142.52	$262.04
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $170.73 / $170.73 / $170.73	Facility	26	$170.73	$170.73	$170.73
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $357.27 / $357.27 / $357.27	Facility	TC	$357.27	$357.27	$357.27
Medica Facility/Professional Professional Modifier Low / Median / High Price $99.22 / $189.17 / $661.34	Professional		$99.22	$189.17	$661.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.56 / $57.89 / $278.39	Professional	26	$35.56	$57.89	$278.39
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $60.70 / $103.64 / $424.71	Professional	TC	$60.70	$103.64	$424.71
Midlands Facility/Professional Facility Modifier Low / Median / High Price $125.24 / $167.87 / $224.48	Facility		$125.24	$167.87	$224.48
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $109.73 / $109.73 / $109.73	Facility	26	$109.73	$109.73	$109.73
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $171.23 / $171.23 / $171.23	Facility	TC	$171.23	$171.23	$171.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $130.61 / $184.00 / $255.81	Professional		$130.61	$184.00	$255.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.47 / $102.49 / $187.04	Professional		$33.47	$102.49	$187.04
United Facility/Professional Professional Modifier Low / Median / High Price $99.22 / $102.20 / $282.82	Professional		$99.22	$102.20	$282.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.53 / $36.63 / $83.25	Professional	26	$35.53	$36.63	$83.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.66 / $65.56 / $149.02	Professional	TC	$63.66	$65.56	$149.02
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $191.20 / $224.90 / $264.50	Professional		$191.20	$224.90	$264.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.30 / $67.40 / $79.30	Professional	26	$57.30	$67.40	$79.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $133.90 / $157.50 / $185.30	Professional	TC	$133.90	$157.50	$185.30