Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $812.83 / $2,454.71	Facility		$309.03	$812.83	$2,454.71
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $107.15 / $331.13	Facility	26	$70.79	$107.15	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $281.84 / $1,023.29	Professional		$173.78	$281.84	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $346.74	Professional	26	$63.10	$77.62	$346.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $181.97 / $691.83	Professional	TC	$117.49	$181.97	$691.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $457.09 / $602.56	Professional		$295.12	$457.09	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $144.54 / $194.98	Professional	26	$87.10	$144.54	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $295.12 / $436.52	Professional	TC	$194.98	$295.12	$436.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $316.23 / $776.25	Professional		$173.78	$316.23	$776.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $114.82 / $288.40	Professional	26	$64.57	$114.82	$288.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $204.17 / $537.03	Professional	TC	$114.82	$204.17	$537.03
Medica Facility/Professional Facility Modifier Low / Median / High Price $269.15 / $549.54 / $1,513.56	Facility		$269.15	$549.54	$1,513.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $309.03 / $309.03 / $309.03	Facility	26	$309.03	$309.03	$309.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $398.11 / $3,981.07	Professional		$213.80	$398.11	$3,981.07
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $112.20 / $436.52	Professional	26	$75.86	$112.20	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $251.19 / $1,000.00	Professional	TC	$134.90	$251.19	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $512.86 / $588.84	Professional		$398.11	$512.86	$588.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $158.49 / $190.55	Professional	26	$144.54	$158.49	$190.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $338.84 / $436.52	Professional	TC	$251.19	$338.84	$436.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $537.03 / $588.84	Professional		$363.08	$537.03	$588.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $169.82 / $186.21	Professional	26	$117.49	$169.82	$186.21
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $436.52	Professional	TC	$245.47	$354.81	$436.52
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $1,288.25 / $3,630.78	Facility		$549.54	$1,288.25	$3,630.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $186.21 / $389.05	Professional		$70.79	$186.21	$389.05
United Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $1,380.38 / $1,778.28	Facility		$794.33	$1,380.38	$1,778.28
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $331.13 / $549.54	Professional		$213.80	$331.13	$549.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $107.15 / $204.17	Professional	26	$75.86	$107.15	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $223.87 / $354.81	Professional	TC	$134.90	$223.87	$354.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $389.05 / $457.09	Professional		$389.05	$389.05	$457.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $158.49	Professional	26	$134.90	$134.90	$158.49
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $251.19 / $295.12	Professional	TC	$251.19	$251.19	$295.12