Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $257.04 / $812.83	Facility		$97.72	$257.04	$812.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.91 / $35.48 / $53.70	Facility	26	$22.91	$35.48	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $120.23 / $478.63	Professional		$72.44	$120.23	$478.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $52.48 / $138.04	Professional	26	$23.99	$52.48	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $89.13 / $218.78	Professional	TC	$54.95	$89.13	$218.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $245.47 / $251.19	Facility		$239.88	$245.47	$251.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $85.11 / $87.10	Facility	26	$83.18	$85.11	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $275.42 / $338.84	Professional		$199.53	$275.42	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $63.10 / $77.62	Professional	26	$58.88	$63.10	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $213.80 / $263.03	Professional	TC	$162.18	$213.80	$263.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $162.18 / $363.08	Professional		$112.20	$162.18	$363.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $51.29 / $177.83	Professional	26	$26.92	$51.29	$177.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $117.49 / $204.17	Professional	TC	$74.13	$117.49	$204.17
Medica Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $218.78 / $512.86	Facility		$100.00	$218.78	$512.86
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $134.90 / $134.90	Facility	26	$85.11	$134.90	$134.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $165.96 / $562.34	Professional		$75.86	$165.96	$562.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $32.36 / $169.82	Professional	26	$25.70	$32.36	$169.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $89.13 / $588.84	Professional	TC	$43.65	$89.13	$588.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $223.87 / $302.00	Professional		$199.53	$223.87	$302.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $57.54 / $95.50	Professional	26	$53.70	$57.54	$95.50
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $173.78 / $229.09	Professional	TC	$141.25	$173.78	$229.09
Midlands Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $251.19 / $251.19	Facility		$251.19	$251.19	$251.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $87.10 / $87.10	Facility	26	$87.10	$87.10	$87.10
Midlands Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $295.12 / $309.03	Professional		$158.49	$295.12	$309.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $67.61 / $72.44	Professional	26	$53.70	$67.61	$72.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $223.87 / $239.88	Professional	TC	$104.71	$223.87	$239.88
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Facility		$288.40	$288.40	$288.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $177.83 / $316.23	Professional		$141.25	$177.83	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $114.82 / $218.78	Professional		$72.44	$114.82	$218.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $30.90 / $70.79	Professional	26	$26.30	$30.90	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $85.11 / $165.96	Professional	TC	$46.77	$85.11	$165.96
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $194.98 / $229.09	Professional		$128.82	$194.98	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $44.67 / $128.82	Professional	26	$44.67	$44.67	$128.82
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $147.91 / $173.78	Professional	TC	$128.82	$147.91	$173.78