Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $158.49 / $501.19	Facility		$102.33	$158.49	$501.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $46.77 / $97.72	Facility	26	$21.38	$46.77	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $363.08	Professional		$107.15	$138.04	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.84 / $93.33	Professional	26	$20.89	$28.84	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $102.33 / $213.80	Professional	TC	$85.11	$102.33	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $263.03 / $436.52	Professional		$131.83	$263.03	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $47.86 / $63.10	Professional	26	$24.55	$47.86	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $213.80 / $380.19	Professional	TC	$107.15	$213.80	$380.19
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $234.42 / $446.68	Professional		$114.82	$234.42	$446.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $39.81 / $83.18	Professional	26	$22.91	$39.81	$83.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $186.21 / $363.08	Professional	TC	$85.11	$186.21	$363.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $251.19 / $524.81	Facility		$134.90	$251.19	$524.81
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Facility	26	$104.71	$104.71	$104.71
Medica Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $239.88 / $1,023.29	Professional		$138.04	$239.88	$1,023.29
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $43.65 / $218.78	Professional	26	$25.12	$43.65	$218.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $186.21 / $891.25	Professional	TC	$102.33	$186.21	$891.25
Midlands Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $281.84 / $316.23	Professional		$223.87	$281.84	$316.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $57.54 / $61.66	Professional	26	$46.77	$57.54	$61.66
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $223.87 / $257.04	Professional	TC	$177.83	$223.87	$257.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $309.03 / $346.74	Professional		$281.84	$309.03	$346.74
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $58.88 / $63.10	Professional	26	$38.90	$58.88	$63.10
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $263.03 / $281.84	Professional	TC	$223.87	$263.03	$281.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $109.65 / $234.42	Professional		$25.70	$109.65	$234.42
United Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $263.03 / $338.84	Facility		$151.36	$263.03	$338.84
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $204.17 / $338.84	Professional		$123.03	$204.17	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $38.02 / $64.57	Professional	26	$24.55	$38.02	$64.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $169.82 / $269.15	Professional	TC	$97.72	$169.82	$269.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $251.19	Professional		$213.80	$213.80	$251.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $50.12	Professional	26	$42.66	$42.66	$50.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $173.78 / $204.17	Professional	TC	$173.78	$173.78	$204.17