Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.59 / $427.28 / $802.07	Facility		$98.59	$427.28	$802.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.17 / $47.82 / $89.99	Facility	26	$25.17	$47.82	$89.99
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $72.45 / $247.19 / $499.50	Facility	TC	$72.45	$247.19	$499.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.93 / $107.68 / $543.00	Professional		$76.93	$107.68	$543.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $37.47 / $145.50	Professional	26	$25.17	$37.47	$145.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.76 / $71.59 / $207.00	Professional	TC	$51.76	$71.59	$207.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $334.80 / $344.84 / $354.89	Facility		$334.80	$344.84	$354.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.64 / $91.30 / $93.96	Facility	26	$88.64	$91.30	$93.96
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $246.17 / $253.56 / $260.94	Facility	TC	$246.17	$253.56	$260.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.67 / $203.23 / $276.23	Professional		$96.67	$203.23	$276.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.33 / $63.61 / $81.98	Professional	26	$32.33	$63.61	$81.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.33 / $139.63 / $192.41	Professional	TC	$64.33	$139.63	$192.41
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $76.15 / $128.44 / $309.51	Professional		$76.15	$128.44	$309.51
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.93 / $42.20 / $107.99	Professional	26	$25.93	$42.20	$107.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.22 / $84.88 / $158.19	Professional	TC	$50.22	$84.88	$158.19
Medica Facility/Professional Facility Modifier Low / Median / High Price $92.32 / $189.29 / $470.80	Facility		$92.32	$189.29	$470.80
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $91.30 / $125.66 / $125.66	Facility	26	$91.30	$125.66	$125.66
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $253.56 / $267.93 / $476.72	Facility	TC	$253.56	$267.93	$476.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.68 / $142.63 / $568.24	Professional		$89.68	$142.63	$568.24
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.63 / $38.20 / $227.85	Professional	26	$28.63	$38.20	$227.85
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $59.62 / $75.58 / $390.02	Professional	TC	$59.62	$75.58	$390.02
Midlands Facility/Professional Facility Modifier Low / Median / High Price $93.57 / $170.28 / $296.32	Facility		$93.57	$170.28	$296.32
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $91.30 / $93.96 / $153.72	Facility	26	$91.30	$93.96	$153.72
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $253.56 / $260.94 / $321.30	Facility	TC	$253.56	$260.94	$321.30
Midlands Facility/Professional Professional Modifier Low / Median / High Price $142.63 / $185.02 / $243.15	Professional		$142.63	$185.02	$243.15
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $100.50 / $665.70 / $1,355.18	Facility		$100.50	$665.70	$1,355.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.85 / $79.89 / $142.60	Professional		$27.85	$79.89	$142.60
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 $88.11 / $103.85 / $196.27	Professional		$88.11	$103.85	$196.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.45 / $36.44 / $69.23	Professional	26	$28.45	$36.44	$69.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.62 / $73.92 / $131.32	Professional	TC	$59.62	$73.92	$131.32
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $121.74 / $154.10 / $181.30	Professional		$121.74	$154.10	$181.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $49.20 / $57.90	Professional	26	$38.86	$49.20	$57.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $82.87 / $104.90 / $123.50	Professional	TC	$82.87	$104.90	$123.50