Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.59 / $162.12 / $229.68	Facility		$74.59	$162.12	$229.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.14 / $58.14 / $58.14	Facility	26	$58.14	$58.14	$58.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.33 / $110.82 / $443.28	Professional		$85.33	$110.82	$443.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $39.20 / $205.41	Professional	26	$30.60	$39.20	$205.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.73 / $64.83 / $148.97	Professional	TC	$54.73	$64.83	$148.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.47 / $207.86 / $373.31	Professional		$81.47	$207.86	$373.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.11 / $78.23 / $139.13	Professional	26	$45.11	$78.23	$139.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.32 / $142.12 / $198.17	Professional	TC	$40.32	$142.12	$198.17
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $116.72 / $188.18 / $279.13	Professional		$116.72	$188.18	$279.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.21 / $66.13 / $180.21	Professional	26	$41.21	$66.13	$180.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $73.31 / $104.76 / $123.45	Professional	TC	$73.31	$104.76	$123.45
Medica Facility/Professional Facility Modifier Low / Median / High Price $131.41 / $181.16 / $396.75	Facility		$131.41	$181.16	$396.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $221.64 / $221.64 / $221.64	Facility	26	$221.64	$221.64	$221.64
Medica Facility/Professional Professional Modifier Low / Median / High Price $118.05 / $207.86 / $764.45	Professional		$118.05	$207.86	$764.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $42.61 / $66.05 / $310.87	Professional	26	$42.61	$66.05	$310.87
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $71.06 / $122.82 / $507.20	Professional	TC	$71.06	$122.82	$507.20
Midlands Facility/Professional Facility Modifier Low / Median / High Price $138.65 / $201.00 / $268.49	Facility		$138.65	$201.00	$268.49
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $137.11 / $137.11 / $137.11	Facility	26	$137.11	$137.11	$137.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.65 / $214.12 / $318.31	Professional		$138.65	$214.12	$318.31
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.72 / $108.82 / $201.04	Professional		$39.72	$108.82	$201.04
United Facility/Professional Professional Modifier Low / Median / High Price $118.05 / $121.59 / $276.36	Professional		$118.05	$121.59	$276.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.61 / $43.89 / $103.35	Professional	26	$42.61	$43.89	$103.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.44 / $81.13 / $176.61	Professional	TC	$75.44	$81.13	$176.61
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $202.60 / $238.30 / $280.20	Professional		$202.60	$238.30	$280.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $68.09 / $80.09 / $94.20	Professional	26	$68.09	$80.09	$94.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.50 / $158.19 / $186.00	Professional	TC	$134.50	$158.19	$186.00