Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $76.14 / $208.55 / $430.65	Facility		$76.14	$208.55	$430.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.65 / $18.32 / $34.85	Facility	26	$9.65	$18.32	$34.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.54 / $254.80 / $317.33	Facility	TC	$40.54	$254.80	$317.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.46 / $43.74 / $165.00	Professional		$34.46	$43.74	$165.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $12.56 / $52.42	Professional	26	$9.65	$12.56	$52.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.80 / $29.85 / $80.09	Professional	TC	$24.80	$29.85	$80.09
Cigna Facility/Professional Facility Modifier Low / Median / High Price $122.78 / $126.46 / $130.15	Facility		$122.78	$126.46	$130.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.72 / $35.77 / $36.81	Facility	26	$34.72	$35.77	$36.81
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $88.05 / $90.69 / $93.33	Facility	TC	$88.05	$90.69	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.77 / $92.31 / $115.39	Professional		$39.77	$92.31	$115.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.34 / $24.05 / $33.44	Professional	26	$11.34	$24.05	$33.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.39 / $68.26 / $85.33	Professional	TC	$27.39	$68.26	$85.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.65 / $54.55 / $82.38	Professional		$34.65	$54.55	$82.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.96 / $16.14 / $33.83	Professional	26	$9.96	$16.14	$33.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $36.79 / $49.57	Professional	TC	$24.69	$36.79	$49.57
Medica Facility/Professional Facility Modifier Low / Median / High Price $50.22 / $84.68 / $264.62	Facility		$50.22	$84.68	$264.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $35.77 / $100.00 / $100.00	Facility	26	$35.77	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $90.69 / $131.69 / $277.00	Facility	TC	$90.69	$131.69	$277.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $57.94 / $254.22	Professional		$35.40	$57.94	$254.22
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $14.38 / $90.81	Professional	26	$11.04	$14.38	$90.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.37 / $32.47 / $195.00	Professional	TC	$24.37	$32.47	$195.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $66.00 / $84.68 / $134.72	Facility		$66.00	$84.68	$134.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $35.77 / $36.81 / $60.06	Facility	26	$35.77	$36.81	$60.06
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $90.69 / $93.33 / $155.52	Facility	TC	$90.69	$93.33	$155.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $61.00 / $77.27 / $120.60	Professional		$61.00	$77.27	$120.60
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $90.88 / $989.10 / $2,013.53	Facility		$90.88	$989.10	$2,013.53
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.45 / $30.44 / $66.63	Professional		$10.45	$30.44	$66.63
United Facility/Professional Facility Modifier Low / Median / High Price $107.74 / $109.22 / $161.80	Facility		$107.74	$109.22	$161.80
United Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $44.55 / $74.09	Professional		$35.40	$44.55	$74.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $13.85 / $23.32	Professional	26	$11.04	$13.85	$23.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.37 / $30.41 / $49.65	Professional	TC	$24.37	$30.41	$49.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $53.64 / $67.90 / $79.90	Professional		$53.64	$67.90	$79.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.46 / $18.30 / $21.50	Professional	26	$14.46	$18.30	$21.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $39.26 / $49.70 / $58.40	Professional	TC	$39.26	$49.70	$58.40