Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.05 / $392.18 / $676.36	Facility		$98.05	$392.18	$676.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.23 / $46.03 / $85.06	Facility	26	$24.23	$46.03	$85.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.92 / $128.09 / $548.00	Professional		$96.92	$128.09	$548.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $36.33 / $139.11	Professional	26	$24.07	$36.33	$139.11
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.92 / $52.11 / $107.53	Professional	52	$46.92	$52.11	$107.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.70 / $90.10 / $454.00	Professional	TC	$72.70	$90.10	$454.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $373.61 / $384.82 / $396.03	Facility		$373.61	$384.82	$396.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.88 / $85.37 / $87.85	Facility	26	$82.88	$85.37	$87.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $101.70 / $257.52 / $321.92	Professional		$101.70	$257.52	$321.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.13 / $61.28 / $78.90	Professional	26	$30.13	$61.28	$78.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.87 / $196.25 / $245.32	Professional	TC	$74.87	$196.25	$245.32
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $97.70 / $148.66 / $320.68	Professional		$97.70	$148.66	$320.68
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.96 / $40.72 / $107.58	Professional	26	$24.96	$40.72	$107.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.38 / $108.59 / $254.78	Professional	TC	$70.38	$108.59	$254.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $103.70 / $215.15 / $453.56	Facility		$103.70	$215.15	$453.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.37 / $122.00 / $122.00	Facility	26	$85.37	$122.00	$122.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $105.32 / $165.58 / $726.73	Professional		$105.32	$165.58	$726.73
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.51 / $35.86 / $255.92	Professional	26	$27.51	$35.86	$255.92
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $76.65 / $105.06 / $554.94	Professional	TC	$76.65	$105.06	$554.94
Midlands Facility/Professional Facility Modifier Low / Median / High Price $171.00 / $240.12 / $384.82	Facility		$171.00	$240.12	$384.82
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $85.37 / $87.85 / $147.84	Facility	26	$85.37	$87.85	$147.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $149.00 / $233.42 / $289.89	Professional		$149.00	$233.42	$289.89
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $214.58 / $760.62 / $1,548.41	Facility		$214.58	$760.62	$1,548.41
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.15 / $100.20 / $184.25	Professional		$27.15	$100.20	$184.25
United Facility/Professional Facility Modifier Low / Median / High Price $147.11 / $151.31 / $217.94	Facility		$147.11	$151.31	$217.94
United Facility/Professional Professional Modifier Low / Median / High Price $105.32 / $140.91 / $238.08	Professional		$105.32	$140.91	$238.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.21 / $33.04 / $63.28	Professional	26	$26.21	$33.04	$63.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.68 / $96.81 / $175.80	Professional	TC	$80.68	$96.81	$175.80
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $153.66 / $194.50 / $228.80	Professional		$153.66	$194.50	$228.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $37.45 / $47.40 / $55.80	Professional	26	$37.45	$47.40	$55.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $116.13 / $147.00 / $173.00	Professional	TC	$116.13	$147.00	$173.00