Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $163.21 / $326.91 / $326.91	Facility		$163.21	$326.91	$326.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.31 / $59.31 / $74.16	Facility	26	$59.31	$59.31	$74.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.21 / $135.68 / $342.89	Professional		$113.21	$135.68	$342.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.62 / $22.21 / $55.08	Professional	26	$12.62	$22.21	$55.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.06 / $112.26 / $267.58	Professional	TC	$91.06	$112.26	$267.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.69 / $246.95 / $393.92	Professional		$140.69	$246.95	$393.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.82 / $32.75 / $55.60	Professional	26	$14.82	$32.75	$55.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.93 / $212.79 / $332.68	Professional	TC	$117.93	$212.79	$332.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $131.87 / $231.86 / $536.67	Professional		$131.87	$231.86	$536.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.96 / $31.85 / $84.86	Professional	26	$20.96	$31.85	$84.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.90 / $196.26 / $433.42	Professional	TC	$110.90	$196.26	$433.42
Medica Facility/Professional Facility Modifier Low / Median / High Price $145.11 / $249.66 / $409.62	Facility		$145.11	$249.66	$409.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $52.72 / $102.96 / $102.96	Facility	26	$52.72	$102.96	$102.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.18 / $286.92 / $1,197.25	Professional		$173.18	$286.92	$1,197.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $17.93 / $37.36 / $198.13	Professional	26	$17.93	$37.36	$198.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $138.13 / $259.02 / $1,126.14	Professional	TC	$138.13	$259.02	$1,126.14
Midlands Facility/Professional Facility Modifier Low / Median / High Price $196.03 / $277.83 / $309.36	Facility		$196.03	$277.83	$309.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $196.03 / $277.83 / $393.92	Professional		$196.03	$277.83	$393.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $150.90 / $398.50 / $612.70	Professional		$150.90	$398.50	$612.70
United Facility/Professional Professional Modifier Low / Median / High Price $158.43 / $246.08 / $390.21	Professional		$158.43	$246.08	$390.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.55 / $35.03 / $61.80	Professional	26	$19.55	$35.03	$61.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.81 / $216.10 / $331.01	Professional	TC	$132.81	$216.10	$331.01
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $211.33 / $267.50 / $327.20	Professional		$211.33	$267.50	$327.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $33.10 / $41.90 / $51.30	Professional	26	$33.10	$41.90	$51.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $178.15 / $225.50 / $276.00	Professional	TC	$178.15	$225.50	$276.00