Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.31 / $326.95 / $528.29	Facility		$117.31	$326.95	$528.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.25 / $59.37 / $95.94	Facility	26	$31.25	$59.37	$95.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.10 / $142.72 / $565.00	Professional		$117.10	$142.72	$565.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.93 / $24.06 / $111.00	Professional	26	$19.93	$24.06	$111.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.16 / $108.55 / $189.29	Professional	TC	$97.16	$108.55	$189.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.85 / $311.26 / $583.98	Professional		$158.85	$311.26	$583.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.61 / $53.10 / $71.87	Professional	26	$22.61	$53.10	$71.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.77 / $255.96 / $496.86	Professional	TC	$137.77	$255.96	$496.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $191.79 / $519.84	Professional		$125.89	$191.79	$519.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.04 / $32.70 / $86.65	Professional	26	$21.04	$32.70	$86.65
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $101.59 / $159.11 / $416.70	Professional	TC	$101.59	$159.11	$416.70
Medica Facility/Professional Facility Modifier Low / Median / High Price $165.82 / $290.82 / $484.66	Facility		$165.82	$290.82	$484.66
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $161.00 / $161.00 / $161.00	Facility	26	$161.00	$161.00	$161.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $167.10 / $295.70 / $1,223.39	Professional		$167.10	$295.70	$1,223.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.90 / $48.45 / $237.75	Professional	26	$24.90	$48.45	$237.75
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $133.24 / $253.74 / $1,114.63	Professional	TC	$133.24	$253.74	$1,114.63
Midlands Facility/Professional Facility Modifier Low / Median / High Price $235.00 / $295.70 / $362.70	Facility		$235.00	$295.70	$362.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $185.00 / $280.98 / $363.85	Professional		$185.00	$280.98	$363.85
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $24.68 / $132.99 / $250.42	Professional		$24.68	$132.99	$250.42
United Facility/Professional Professional Modifier Low / Median / High Price $153.02 / $253.82 / $378.76	Professional		$153.02	$253.82	$378.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.90 / $39.52 / $63.62	Professional	26	$24.90	$39.52	$63.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.12 / $232.88 / $315.14	Professional	TC	$128.12	$232.88	$315.14
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $206.90 / $261.89 / $308.10	Professional		$206.90	$261.89	$308.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $32.63 / $41.30 / $48.60	Professional	26	$32.63	$41.30	$48.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $174.27 / $220.60 / $259.60	Professional	TC	$174.27	$220.60	$259.60