Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $309.03 / $2,511.89	Facility		$128.82	$309.03	$2,511.89
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $74.13 / $169.82	Facility	26	$70.79	$74.13	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $158.49 / $416.87	Professional		$120.23	$158.49	$416.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $81.28 / $251.19	Professional	26	$51.29	$81.28	$251.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	52	$125.89	$125.89	$125.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $77.62 / $263.03	Professional	TC	$57.54	$77.62	$263.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $645.65 / $676.08	Facility		$630.96	$645.65	$676.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $173.78 / $177.83	Facility	26	$165.96	$173.78	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $346.74 / $524.81	Professional		$194.98	$346.74	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $181.97 / $223.87	Professional	26	$72.44	$181.97	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $173.78 / $389.05	Professional	TC	$95.50	$173.78	$389.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $251.19 / $912.01	Professional		$134.90	$251.19	$912.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $107.15 / $467.74	Professional	26	$75.86	$107.15	$467.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $114.82 / $562.34	Professional	TC	$60.26	$114.82	$562.34
Medica Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $602.56 / $7,585.78	Facility		$218.78	$602.56	$7,585.78
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $363.08 / $363.08	Facility	26	$190.55	$363.08	$363.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $316.23 / $3,090.30	Professional		$169.82	$316.23	$3,090.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $107.15 / $549.54	Professional	26	$61.66	$107.15	$549.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $151.36 / $2,818.38	Professional	TC	$77.62	$151.36	$2,818.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $380.19 / $645.65	Professional		$295.12	$380.19	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $190.55 / $245.47	Professional	26	$131.83	$190.55	$245.47
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $173.78 / $512.86	Professional	TC	$131.83	$173.78	$512.86
Midlands Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $676.08 / $676.08	Facility		$676.08	$676.08	$676.08
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $177.83 / $177.83	Facility	26	$177.83	$177.83	$177.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $346.74 / $645.65	Professional		$316.23	$346.74	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $169.82 / $204.17	Professional	26	$104.71	$169.82	$204.17
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $204.17 / $512.86	Professional	TC	$158.49	$204.17	$512.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $134.90 / $269.15	Professional		$69.18	$134.90	$269.15
United Facility/Professional Facility Modifier Low / Median / High Price $4,168.69 / $7,244.36 / $9,772.37	Facility		$4,168.69	$7,244.36	$9,772.37
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $229.09 / $446.68	Professional		$154.88	$229.09	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $97.72 / $173.78	Professional	26	$61.66	$97.72	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $109.65 / $346.74	Professional	TC	$70.79	$109.65	$346.74
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $295.12	Professional		$251.19	$251.19	$295.12
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $162.18	Professional	26	$138.04	$138.04	$162.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $114.82 / $134.90	Professional	TC	$114.82	$114.82	$134.90