Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $208.93 / $562.34	Facility		$85.11	$208.93	$562.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $42.66 / $66.07	Facility	26	$28.84	$42.66	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $114.82 / $457.09	Professional		$50.12	$114.82	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $69.18 / $190.55	Professional	26	$30.20	$69.18	$190.55
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $75.86 / $229.09 / $707.95	Professional	50	$75.86	$229.09	$707.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $61.66 / $281.84	Professional	TC	$43.65	$61.66	$281.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $281.84 / $295.12	Facility		$275.42	$281.84	$295.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $109.65 / $114.82	Facility	26	$107.15	$109.65	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $204.17 / $251.19	Professional		$93.33	$204.17	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $75.86 / $93.33	Professional	26	$37.15	$75.86	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $125.89 / $158.49	Professional	TC	$56.23	$125.89	$158.49
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $213.80 / $257.04	Professional		$83.18	$213.80	$257.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $97.72 / $134.90	Professional	26	$33.11	$97.72	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $100.00 / $128.82	Professional	TC	$51.29	$100.00	$128.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $181.97 / $371.54	Facility		$81.28	$181.97	$371.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $147.91 / $147.91	Facility	26	$109.65	$147.91	$147.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $138.04 / $549.54	Professional		$83.18	$138.04	$549.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $43.65 / $204.17	Professional	26	$33.11	$43.65	$204.17
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $331.13 / $363.08 / $416.87	Professional	50	$331.13	$363.08	$416.87
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $64.57 / $338.84	Professional	TC	$46.77	$64.57	$338.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $181.97 / $218.78	Professional		$165.96	$181.97	$218.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $70.79 / $81.28	Professional	26	$64.57	$70.79	$81.28
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $112.20 / $134.90	Professional	TC	$100.00	$112.20	$134.90
Midlands Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Facility		$295.12	$295.12	$295.12
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $213.80 / $234.42	Professional		$165.96	$213.80	$234.42
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $81.28 / $89.13	Professional	26	$64.57	$81.28	$89.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $134.90 / $144.54	Professional	TC	$102.33	$134.90	$144.54
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $724.44 / $2,041.74	Facility		$213.80	$724.44	$2,041.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $69.18 / $141.25	Professional		$33.11	$69.18	$141.25
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $199.53 / $269.15	Facility		$114.82	$199.53	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $100.00 / $186.21	Professional		$83.18	$100.00	$186.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $39.81 / $74.13	Professional	26	$33.11	$39.81	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $58.88 / $112.20	Professional	TC	$48.98	$58.88	$112.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $151.36 / $177.83	Professional		$151.36	$151.36	$177.83
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $67.61	Professional	26	$57.54	$57.54	$67.61
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $109.65	Professional	TC	$93.33	$93.33	$109.65