Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $209.70 / $435.85 / $1,063.11	Facility		$209.70	$435.85	$1,063.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.31 / $97.48 / $157.52	Facility	26	$51.31	$97.48	$157.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.99 / $212.66 / $460.21	Professional		$169.99	$212.66	$460.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.83 / $37.10 / $74.15	Professional	26	$30.83	$37.10	$74.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.86 / $162.49 / $253.80	Professional	TC	$131.86	$162.49	$253.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.54 / $431.91 / $718.38	Professional		$197.54	$431.91	$718.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.74 / $88.21 / $119.32	Professional	26	$37.74	$88.21	$119.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $156.77 / $340.59 / $588.05	Professional	TC	$156.77	$340.59	$588.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $155.97 / $264.20 / $600.03	Professional		$155.97	$264.20	$600.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $56.12 / $96.79	Professional	26	$35.65	$56.12	$96.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.31 / $195.40 / $473.02	Professional	TC	$120.31	$195.40	$473.02
Medica Facility/Professional Facility Modifier Low / Median / High Price $242.22 / $417.89 / $658.72	Facility		$242.22	$417.89	$658.72
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $172.60 / $172.60 / $172.60	Facility	26	$172.60	$172.60	$172.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $216.89 / $386.82 / $1,459.71	Professional		$216.89	$386.82	$1,459.71
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.42 / $78.08 / $361.59	Professional	26	$40.42	$78.08	$361.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $157.69 / $295.35 / $1,274.61	Professional	TC	$157.69	$295.35	$1,274.61
Midlands Facility/Professional Facility Modifier Low / Median / High Price $333.74 / $392.67 / $489.27	Facility		$333.74	$392.67	$489.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $277.14 / $370.36 / $489.27	Professional		$277.14	$370.36	$489.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.64 / $166.08 / $323.36	Professional		$40.64	$166.08	$323.36
United Facility/Professional Professional Modifier Low / Median / High Price $192.40 / $314.18 / $500.24	Professional		$192.40	$314.18	$500.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.42 / $60.45 / $102.76	Professional	26	$40.42	$60.45	$102.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.58 / $265.99 / $386.90	Professional	TC	$151.58	$265.99	$386.90
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $261.89 / $331.50 / $390.10	Professional		$261.89	$331.50	$390.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $55.54 / $70.30 / $82.60	Professional	26	$55.54	$70.30	$82.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $206.43 / $261.30 / $307.39	Professional	TC	$206.43	$261.30	$307.39