Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $113.31 / $372.40 / $973.69	Facility		$113.31	$372.40	$973.69
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.41 / $45.37 / $135.59	Facility	26	$24.41	$45.37	$135.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.17 / $101.17 / $242.62	Professional		$75.17	$101.17	$242.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.88 / $34.34 / $148.00	Professional	26	$23.88	$34.34	$148.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $77.28 / $178.38	Professional	TC	$49.89	$77.28	$178.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $237.51 / $244.64 / $251.76	Facility		$237.51	$244.64	$251.76
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.61 / $85.09 / $87.57	Facility	26	$82.61	$85.09	$87.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $157.47 / $267.62 / $334.52	Professional		$157.47	$267.62	$334.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.21 / $60.50 / $75.63	Professional	26	$56.21	$60.50	$75.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.26 / $207.11 / $258.89	Professional	TC	$138.26	$207.11	$258.89
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $98.93 / $148.63 / $298.63	Professional		$98.93	$148.63	$298.63
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.59 / $37.95 / $123.03	Professional	26	$24.59	$37.95	$123.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.34 / $116.16 / $147.81	Professional	TC	$74.34	$116.16	$147.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $97.53 / $195.67 / $299.60	Facility		$97.53	$195.67	$299.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.09 / $136.28 / $136.28	Facility	26	$85.09	$136.28	$136.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $93.87 / $194.83 / $752.82	Professional		$93.87	$194.83	$752.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.15 / $40.72 / $169.69	Professional	26	$27.15	$40.72	$169.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $50.93 / $112.09 / $583.14	Professional	TC	$50.93	$112.09	$583.14
Midlands Facility/Professional Facility Modifier Low / Median / High Price $139.00 / $232.40 / $299.60	Facility		$139.00	$232.40	$299.60
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $85.09 / $87.57 / $147.54	Facility	26	$85.09	$87.57	$147.54
Midlands Facility/Professional Professional Modifier Low / Median / High Price $140.00 / $225.64 / $299.60	Professional		$140.00	$225.64	$299.60
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $290.39 / $290.39 / $290.39	Facility		$290.39	$290.39	$290.39
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $128.69 / $162.00 / $318.60	Professional		$128.69	$162.00	$318.60
United Facility/Professional Professional Modifier Low / Median / High Price $93.56 / $131.46 / $216.54	Professional		$93.56	$131.46	$216.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.15 / $34.56 / $62.94	Professional	26	$27.15	$34.56	$62.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.49 / $96.10 / $158.30	Professional	TC	$60.49	$96.10	$158.30
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $128.00 / $193.50 / $227.60	Professional		$128.00	$193.50	$227.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $35.39 / $44.80 / $52.70	Professional	26	$35.39	$44.80	$52.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $117.47 / $148.69 / $174.90	Professional	TC	$117.47	$148.69	$174.90