Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.05 / $442.54 / $848.70	Facility		$98.05	$442.54	$848.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.32 / $59.52 / $111.85	Facility	26	$31.32	$59.52	$111.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $89.33 / $196.81 / $569.42	Facility	TC	$89.33	$196.81	$569.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.14 / $133.18 / $639.00	Professional		$95.14	$133.18	$639.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.33 / $39.82 / $181.45	Professional	26	$31.33	$39.82	$181.45
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.59 / $51.13 / $71.66	Professional	52	$45.59	$51.13	$71.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.81 / $87.95 / $201.04	Professional	TC	$63.81	$87.95	$201.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $414.29 / $426.72 / $439.15	Facility		$414.29	$426.72	$439.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $110.66 / $113.98 / $117.30	Facility	26	$110.66	$113.98	$117.30
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $303.63 / $312.74 / $321.85	Facility	TC	$303.63	$312.74	$321.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.69 / $252.10 / $341.73	Professional		$124.69	$252.10	$341.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.01 / $79.12 / $98.90	Professional	26	$40.01	$79.12	$98.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.75 / $172.98 / $250.60	Professional	TC	$84.75	$172.98	$250.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $96.59 / $159.37 / $354.45	Professional		$96.59	$159.37	$354.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.49 / $52.98 / $132.72	Professional	26	$32.49	$52.98	$132.72
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.15 / $100.74 / $180.15	Professional	TC	$62.15	$100.74	$180.15
Medica Facility/Professional Facility Modifier Low / Median / High Price $96.44 / $222.00 / $424.23	Facility		$96.44	$222.00	$424.23
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $113.98 / $157.44 / $157.44	Facility	26	$113.98	$157.44	$157.44
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $285.00 / $331.53 / $453.62	Facility	TC	$285.00	$331.53	$453.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.52 / $174.18 / $704.47	Professional		$111.52	$174.18	$704.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $36.00 / $46.88 / $290.60	Professional	26	$36.00	$46.88	$290.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $73.72 / $97.22 / $483.33	Professional	TC	$73.72	$97.22	$483.33
Midlands Facility/Professional Facility Modifier Low / Median / High Price $93.57 / $222.00 / $365.68	Facility		$93.57	$222.00	$365.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $113.98 / $117.30 / $194.64	Facility	26	$113.98	$117.30	$194.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $312.74 / $321.85 / $396.96	Facility	TC	$312.74	$321.85	$396.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $189.42 / $229.86 / $300.54	Professional		$189.42	$229.86	$300.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.93 / $99.56 / $177.71	Professional		$34.93	$99.56	$177.71
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 $106.21 / $127.45 / $233.66	Professional		$106.21	$127.45	$233.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $43.20 / $82.73	Professional	26	$35.65	$43.20	$82.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.72 / $91.43 / $188.91	Professional	TC	$73.72	$91.43	$188.91
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $151.29 / $191.50 / $225.30	Professional		$151.29	$191.50	$225.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $48.74 / $61.70 / $72.50	Professional	26	$48.74	$61.70	$72.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $102.54 / $129.80 / $152.80	Professional	TC	$102.54	$129.80	$152.80