Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.26 / $172.59 / $4,495.60	Facility		$59.26	$172.59	$4,495.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.02 / $14.85 / $62.04	Facility	26	$8.02	$14.85	$62.04
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.38 / $71.75 / $352.29	Facility	TC	$40.38	$71.75	$352.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.38 / $37.21 / $183.00	Professional		$30.38	$37.21	$183.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.82 / $11.28 / $59.17	Professional	26	$7.82	$11.28	$59.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.79 / $25.93 / $50.15	Professional	TC	$22.79	$25.93	$50.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $115.28 / $118.74 / $122.20	Facility		$115.28	$118.74	$122.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.29 / $37.38 / $38.47	Facility	26	$36.29	$37.38	$38.47
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $78.98 / $81.36 / $83.73	Facility	TC	$78.98	$81.36	$83.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.27 / $83.78 / $117.39	Professional		$36.27	$83.78	$117.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.10 / $21.62 / $29.90	Professional	26	$11.10	$21.62	$29.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.02 / $64.38 / $84.64	Professional	TC	$27.02	$64.38	$84.64
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $31.38 / $52.98 / $99.21	Professional		$31.38	$52.98	$99.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.10 / $14.55 / $30.68	Professional	26	$8.10	$14.55	$30.68
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.27 / $36.51 / $63.84	Professional	TC	$23.27	$36.51	$63.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $46.72 / $76.54 / $289.80	Facility		$46.72	$76.54	$289.80
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $37.38 / $100.00 / $100.00	Facility	26	$37.38	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $81.36 / $124.11 / $124.11	Facility	TC	$81.36	$124.11	$124.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $34.54 / $57.07 / $230.47	Professional		$34.54	$57.07	$230.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.64 / $77.59	Professional	26	$10.47	$13.64	$77.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.07 / $30.74 / $214.00	Professional	TC	$23.07	$30.74	$214.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $66.98 / $76.84 / $122.26	Facility		$66.98	$76.84	$122.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $37.38 / $38.47 / $48.60	Facility	26	$37.38	$38.47	$48.60
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $81.36 / $83.73 / $146.52	Facility	TC	$81.36	$83.73	$146.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $62.00 / $75.72 / $122.26	Professional		$62.00	$75.72	$122.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.83 / $32.11 / $59.96	Professional		$8.83	$32.11	$59.96
United Facility/Professional Facility Modifier Low / Median / High Price $137.03 / $224.21 / $289.80	Facility		$137.03	$224.21	$289.80
United Facility/Professional Professional Modifier Low / Median / High Price $33.24 / $39.75 / $74.40	Professional		$33.24	$39.75	$74.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.92 / $12.57 / $24.24	Professional	26	$9.92	$12.57	$24.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.07 / $27.68 / $48.36	Professional	TC	$23.07	$27.68	$48.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $48.74 / $61.70 / $72.50	Professional		$48.74	$61.70	$72.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $14.80 / $17.50	Professional	26	$11.69	$14.80	$17.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $36.97 / $46.80 / $55.10	Professional	TC	$36.97	$46.80	$55.10