Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $199.53 / $426.58	Facility		$58.88	$199.53	$426.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $10.72 / $21.88	Facility	26	$8.91	$10.72	$21.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.55 / $104.71 / $316.23	Facility	TC	$24.55	$104.71	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $56.23 / $181.97	Professional		$33.11	$56.23	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $16.98 / $50.12	Professional	26	$9.55	$16.98	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $39.81 / $125.89	Professional	TC	$23.99	$39.81	$125.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $125.89 / $128.82	Facility		$123.03	$125.89	$128.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $35.48 / $37.15	Facility	26	$34.67	$35.48	$37.15
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $87.10 / $91.20 / $93.33	Facility	TC	$87.10	$91.20	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $95.50 / $117.49	Professional		$47.86	$95.50	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $24.55 / $30.90	Professional	26	$13.49	$24.55	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $69.18 / $87.10	Professional	TC	$33.88	$69.18	$87.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $54.95 / $93.33	Professional		$35.48	$54.95	$93.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.22 / $50.12	Professional	26	$10.00	$16.22	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $34.67 / $50.12	Professional	TC	$16.60	$34.67	$50.12
Medica Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $100.00 / $346.74	Facility		$50.12	$100.00	$346.74
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $100.00 / $100.00	Facility	26	$35.48	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $91.20 / $131.83 / $275.42	Facility	TC	$91.20	$131.83	$275.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $63.10 / $257.04	Professional		$35.48	$63.10	$257.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.60 / $91.20	Professional	26	$10.96	$16.60	$91.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $36.31 / $194.98	Professional	TC	$22.91	$36.31	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $85.11 / $100.00	Professional		$72.44	$85.11	$100.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $26.30 / $34.67	Professional	26	$21.38	$26.30	$34.67
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $56.23 / $72.44	Professional	TC	$50.12	$56.23	$72.44
Midlands Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $37.15 / $37.15	Facility	26	$37.15	$37.15	$37.15
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	TC	$93.33	$93.33	$93.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $72.44 / $100.00	Professional		$64.57	$72.44	$100.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $25.12 / $32.36	Professional	26	$22.39	$25.12	$32.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $50.12 / $72.44	Professional	TC	$40.74	$50.12	$72.44
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $707.95 / $1,995.26	Facility		$91.20	$707.95	$1,995.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $30.20 / $67.61	Professional		$10.72	$30.20	$67.61
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $199.53 / $269.15	Facility		$114.82	$199.53	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $44.67 / $83.18	Professional		$35.48	$44.67	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.80 / $25.70	Professional	26	$10.96	$13.80	$25.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $30.20 / $57.54	Professional	TC	$23.44	$30.20	$57.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $79.43	Professional		$67.61	$67.61	$79.43
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.20 / $21.38	Professional	26	$18.20	$18.20	$21.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $58.88	Professional	TC	$50.12	$50.12	$58.88