Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $143.58 / $169.70 / $357.59	Professional		$143.58	$169.70	$357.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.51 / $20.11 / $47.49	Professional	26	$17.51	$20.11	$47.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $126.07 / $149.58 / $322.94	Professional	TC	$126.07	$149.58	$322.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.99 / $346.00 / $635.61	Professional		$111.99	$346.00	$635.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.14 / $48.85 / $112.00	Professional	26	$27.14	$48.85	$112.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.62 / $274.00 / $457.58	Professional	TC	$117.62	$274.00	$457.58
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $167.55 / $266.87 / $305.38	Professional		$167.55	$266.87	$305.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.41 / $37.50 / $103.95	Professional	26	$21.41	$37.50	$103.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.13 / $229.55 / $316.64	Professional	TC	$146.13	$229.55	$316.64
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $240.51 / $240.51 / $240.51	Facility	26	$240.51	$240.51	$240.51
Medica Facility/Professional Professional Modifier Low / Median / High Price $156.02 / $275.51 / $1,336.58	Professional		$156.02	$275.51	$1,336.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $49.08 / $315.72	Professional	26	$25.17	$49.08	$315.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $103.95 / $156.99 / $1,188.97	Professional	TC	$103.95	$156.99	$1,188.97
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $136.22 / $136.22 / $136.22	Facility	26	$136.22	$136.22	$136.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $167.56 / $305.07 / $516.42	Professional		$167.56	$305.07	$516.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $22.54 / $174.25 / $322.27	Professional		$22.54	$174.25	$322.27
United Facility/Professional Professional Modifier Low / Median / High Price $156.02 / $172.05 / $405.14	Professional		$156.02	$172.05	$405.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $25.93 / $116.55	Professional	26	$25.17	$25.93	$116.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.87 / $146.12 / $283.74	Professional	TC	$141.87	$146.12	$283.74
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $330.80 / $389.20 / $457.70	Professional		$330.80	$389.20	$457.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $38.60 / $45.40 / $53.40	Professional	26	$38.60	$45.40	$53.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $292.20 / $343.80 / $404.30	Professional	TC	$292.20	$343.80	$404.30