Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.66 / $187.34 / $228.98	Facility		$114.66	$187.34	$228.98
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.27 / $53.27 / $53.27	Facility	26	$53.27	$53.27	$53.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.52 / $157.97 / $780.88	Professional		$120.52	$157.97	$780.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.04 / $32.24 / $58.85	Professional	26	$28.04	$32.24	$58.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.48 / $109.46 / $254.87	Professional	TC	$92.48	$109.46	$254.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.04 / $235.04 / $423.67	Professional		$91.04	$235.04	$423.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.41 / $71.14 / $97.10	Professional	26	$30.41	$71.14	$97.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.28 / $223.30 / $303.55	Professional	TC	$63.28	$223.30	$303.55
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $131.76 / $270.45 / $483.90	Professional		$131.76	$270.45	$483.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.07 / $61.43 / $183.57	Professional	26	$30.07	$61.43	$183.57
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.69 / $209.06 / $330.11	Professional	TC	$101.69	$209.06	$330.11
Medica Facility/Professional Facility Modifier Low / Median / High Price $134.47 / $203.93 / $782.64	Facility		$134.47	$203.93	$782.64
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $213.67 / $213.67 / $213.67	Facility	26	$213.67	$213.67	$213.67
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.79 / $235.04 / $1,081.50	Professional		$111.79	$235.04	$1,081.50
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.74 / $40.77 / $235.79	Professional	26	$38.74	$40.77	$235.79
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $71.02 / $135.34 / $845.71	Professional	TC	$71.02	$135.34	$845.71
Midlands Facility/Professional Facility Modifier Low / Median / High Price $199.89 / $285.06 / $334.92	Facility		$199.89	$285.06	$334.92
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $97.66 / $97.66 / $97.66	Facility	26	$97.66	$97.66	$97.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.89 / $294.45 / $411.37	Professional		$199.89	$294.45	$411.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.11 / $160.40 / $287.17	Professional		$37.11	$160.40	$287.17
United Facility/Professional Professional Modifier Low / Median / High Price $161.32 / $166.16 / $349.37	Professional		$161.32	$166.16	$349.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.71 / $39.90 / $90.69	Professional	26	$38.71	$39.90	$90.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.58 / $126.26 / $252.29	Professional	TC	$122.58	$126.26	$252.29
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $293.30 / $345.10 / $405.80	Professional		$293.30	$345.10	$405.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $63.50 / $74.80 / $87.90	Professional	26	$63.50	$74.80	$87.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $229.80 / $270.30 / $317.89	Professional	TC	$229.80	$270.30	$317.89