Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $239.88 / $851.14	Facility		$213.80	$239.88	$851.14
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $74.13 / $158.49	Facility	26	$34.67	$74.13	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $691.83	Professional		$165.96	$239.88	$691.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $42.66 / $144.54	Professional	26	$33.88	$42.66	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $162.18 / $346.74	Professional	TC	$128.82	$162.18	$346.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $389.05 / $616.60	Professional		$199.53	$389.05	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $77.62 / $107.15	Professional	26	$38.02	$77.62	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $309.03 / $537.03	Professional	TC	$162.18	$309.03	$537.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $323.59 / $645.65	Professional		$162.18	$323.59	$645.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $112.20	Professional	26	$37.15	$57.54	$112.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $239.88 / $549.54	Professional	TC	$128.82	$239.88	$549.54
Medica Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $407.38 / $812.83	Facility		$213.80	$407.38	$812.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $173.78 / $173.78	Facility	26	$173.78	$173.78	$173.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $1,445.44	Professional		$199.53	$371.54	$1,445.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $69.18 / $363.08	Professional	26	$38.90	$69.18	$363.08
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $281.84 / $1,288.25	Professional	TC	$158.49	$281.84	$1,288.25
Midlands Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $436.52 / $489.78	Professional		$354.81	$436.52	$489.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $91.20 / $109.65	Professional	26	$74.13	$91.20	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $338.84 / $398.11	Professional	TC	$281.84	$338.84	$398.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $436.52 / $501.19	Professional		$407.38	$436.52	$501.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $97.72 / $109.65	Professional	26	$57.54	$97.72	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $371.54 / $398.11	Professional	TC	$309.03	$371.54	$398.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $169.82 / $363.08	Professional		$42.66	$169.82	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $602.56 / $776.25	Facility		$346.74	$602.56	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $302.00 / $501.19	Professional		$190.55	$302.00	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $60.26 / $102.33	Professional	26	$38.90	$60.26	$102.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $251.19 / $407.38	Professional	TC	$151.36	$251.19	$407.38
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $389.05	Professional		$331.13	$331.13	$389.05
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $83.18	Professional	26	$70.79	$70.79	$83.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $263.03 / $309.03	Professional	TC	$263.03	$263.03	$309.03