Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $88.05 / $308.32 / $710.84	Facility		$88.05	$308.32	$710.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.16 / $55.40 / $104.20	Facility	26	$29.16	$55.40	$104.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.86 / $94.37 / $444.00	Professional		$51.86	$94.37	$444.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.16 / $39.84 / $122.26	Professional	26	$29.16	$39.84	$122.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $102.89 / $200.00 / $672.00	Professional	50	$102.89	$200.00	$672.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.45 / $54.01 / $145.96	Professional	TC	$45.45	$54.01	$145.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $275.83 / $284.12 / $292.39	Facility		$275.83	$284.12	$292.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.28 / $110.50 / $113.72	Facility	26	$107.28	$110.50	$113.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.14 / $197.80 / $247.25	Professional		$94.14	$197.80	$247.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.01 / $73.69 / $92.11	Professional	26	$38.01	$73.69	$92.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.38 / $124.11 / $155.13	Professional	TC	$56.38	$124.11	$155.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $83.81 / $123.70 / $257.35	Professional		$83.81	$123.70	$257.35
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.97 / $47.89 / $135.74	Professional	26	$32.97	$47.89	$135.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.84 / $70.56 / $129.96	Professional	TC	$50.84	$70.56	$129.96
Medica Facility/Professional Facility Modifier Low / Median / High Price $80.45 / $163.28 / $289.61	Facility		$80.45	$163.28	$289.61
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $110.50 / $146.86 / $146.86	Facility	26	$110.50	$146.86	$146.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $85.39 / $124.80 / $536.60	Professional		$85.39	$124.80	$536.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.36 / $43.21 / $203.94	Professional	26	$33.36	$43.21	$203.94
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $334.80 / $363.19 / $414.04	Professional	50	$334.80	$363.19	$414.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $49.26 / $64.14 / $342.28	Professional	TC	$49.26	$64.14	$342.28
Midlands Facility/Professional Facility Modifier Low / Median / High Price $159.46 / $180.75 / $292.39	Facility		$159.46	$180.75	$292.39
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $110.50 / $113.72 / $179.22	Facility	26	$110.50	$113.72	$179.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $159.46 / $180.75 / $287.56	Professional		$159.46	$180.75	$287.56
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $213.74 / $1,024.80 / $2,086.19	Facility		$213.74	$1,024.80	$2,086.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $32.11 / $76.19 / $141.44	Professional		$32.11	$76.19	$141.44
United Facility/Professional Facility Modifier Low / Median / High Price $107.74 / $109.22 / $161.80	Facility		$107.74	$109.22	$161.80
United Facility/Professional Professional Modifier Low / Median / High Price $82.44 / $104.28 / $181.37	Professional		$82.44	$104.28	$181.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.18 / $41.58 / $76.31	Professional	26	$33.18	$41.58	$76.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.26 / $63.53 / $145.22	Professional	TC	$49.26	$63.53	$145.22
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $118.97 / $150.60 / $177.20	Professional		$118.97	$150.60	$177.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $45.43 / $57.50 / $67.70	Professional	26	$45.43	$57.50	$67.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $73.55 / $93.10 / $109.50	Professional	TC	$73.55	$93.10	$109.50