Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.45 / $168.00 / $344.41	Facility		$54.45	$168.00	$344.41
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.74 / $16.60 / $55.80	Facility	26	$8.74	$16.60	$55.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.53 / $78.65 / $381.26	Facility	TC	$20.53	$78.65	$381.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.66 / $36.58 / $157.00	Professional		$28.66	$36.58	$157.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.74 / $11.21 / $52.42	Professional	26	$8.74	$11.21	$52.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.28 / $23.81 / $58.08	Professional	TC	$19.28	$23.81	$58.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $105.23 / $108.39 / $111.54	Facility		$105.23	$108.39	$111.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.53 / $35.57 / $36.60	Facility	26	$34.53	$35.57	$36.60
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $70.70 / $72.81 / $74.94	Facility	TC	$70.70	$72.81	$74.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.39 / $76.79 / $107.87	Professional		$33.39	$76.79	$107.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.30 / $21.72 / $32.00	Professional	26	$10.30	$21.72	$32.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.09 / $55.07 / $75.00	Professional	TC	$23.09	$55.07	$75.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $28.90 / $49.30 / $80.44	Professional		$28.90	$49.30	$80.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $14.72 / $29.44	Professional	26	$9.02	$14.72	$29.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $30.54 / $41.99	Professional	TC	$19.87	$30.54	$41.99
Medica Facility/Professional Facility Modifier Low / Median / High Price $44.14 / $70.44 / $289.80	Facility		$44.14	$70.44	$289.80
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $35.57 / $100.00 / $100.00	Facility	26	$35.57	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $72.81 / $105.96 / $105.96	Facility	TC	$72.81	$105.96	$105.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $55.00 / $218.00	Professional		$32.36	$55.00	$218.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.09 / $87.52	Professional	26	$10.47	$13.09	$87.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.71 / $26.28 / $206.00	Professional	TC	$20.71	$26.28	$206.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $61.53 / $70.44 / $112.07	Facility		$61.53	$70.44	$112.07
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $35.57 / $36.60 / $54.30	Facility	26	$35.57	$36.60	$54.30
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $72.81 / $74.94 / $124.92	Facility	TC	$72.81	$74.94	$124.92
Midlands Facility/Professional Professional Modifier Low / Median / High Price $61.00 / $69.81 / $112.07	Professional		$61.00	$69.81	$112.07
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $109.17 / $967.24 / $1,670.68	Facility		$109.17	$967.24	$1,670.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.73 / $29.50 / $55.71	Professional		$9.73	$29.50	$55.71
United Facility/Professional Professional Modifier Low / Median / High Price $29.46 / $35.35 / $63.84	Professional		$29.46	$35.35	$63.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.99 / $12.56 / $23.14	Professional	26	$9.99	$12.56	$23.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.56 / $25.35 / $42.69	Professional	TC	$20.56	$25.35	$42.69
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $44.64 / $56.50 / $66.50	Professional		$44.64	$56.50	$66.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.11 / $16.60 / $19.50	Professional	26	$13.11	$16.60	$19.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $31.60 / $40.00 / $47.00	Professional	TC	$31.60	$40.00	$47.00