Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $177.01 / $351.00 / $539.82	Facility		$177.01	$351.00	$539.82
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.52 / $84.19 / $158.22	Facility	26	$42.52	$84.19	$158.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.96 / $225.37 / $825.00	Professional		$140.96	$225.37	$825.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $61.00 / $226.63	Professional	26	$37.95	$61.00	$226.63
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $142.91 / $142.91 / $142.91	Professional	52	$142.91	$142.91	$142.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.42 / $154.90 / $338.29	Professional	TC	$100.42	$154.90	$338.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $259.48 / $346.69 / $404.37	Professional		$259.48	$346.69	$404.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.92 / $93.68 / $126.72	Professional	26	$71.92	$93.68	$126.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $187.56 / $232.49 / $288.24	Professional	TC	$187.56	$232.49	$288.24
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.66 / $175.13 / $477.61	Professional		$112.66	$175.13	$477.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.04 / $55.20 / $201.38	Professional	26	$36.04	$55.20	$201.38
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.62 / $116.99 / $215.76	Professional	TC	$76.62	$116.99	$215.76
Medica Facility/Professional Facility Modifier Low / Median / High Price $152.75 / $296.36 / $439.05	Facility		$152.75	$296.36	$439.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $233.03 / $355.75 / $1,023.12	Professional		$233.03	$355.75	$1,023.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $61.44 / $96.63 / $261.30	Professional	26	$61.44	$96.63	$261.30
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $148.93 / $261.95 / $767.60	Professional	TC	$148.93	$261.95	$767.60
Midlands Facility/Professional Facility Modifier Low / Median / High Price $261.58 / $346.69 / $419.72	Facility		$261.58	$346.69	$419.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $238.35 / $329.53 / $421.23	Professional		$238.35	$329.53	$421.23
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $217.34 / $217.34 / $217.34	Facility		$217.34	$217.34	$217.34
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $39.32 / $128.57 / $233.10	Professional		$39.32	$128.57	$233.10
United Facility/Professional Professional Modifier Low / Median / High Price $178.65 / $346.43 / $422.55	Professional		$178.65	$346.43	$422.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.15 / $91.34 / $112.99	Professional	26	$49.15	$91.34	$112.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.55 / $242.54 / $311.14	Professional	TC	$131.55	$242.54	$311.14
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $202.95 / $256.89 / $302.20	Professional		$202.95	$256.89	$302.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $60.59 / $76.70 / $90.30	Professional	26	$60.59	$76.70	$90.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $142.36 / $180.20 / $212.00	Professional	TC	$142.36	$180.20	$212.00