Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $120.23 / $426.58	Facility		$30.20	$120.23	$426.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $9.33 / $20.89	Facility	26	$7.94	$9.33	$20.89
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $61.66 / $363.08	Facility	TC	$19.95	$61.66	$363.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $52.48 / $173.78	Professional		$26.92	$52.48	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $16.22 / $50.12	Professional	26	$7.94	$16.22	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $32.36 / $95.50	Professional	TC	$18.20	$32.36	$95.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $107.15 / $112.20	Facility		$104.71	$107.15	$112.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $35.48 / $36.31	Facility	26	$34.67	$35.48	$36.31
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $70.79 / $72.44 / $74.13	Facility	TC	$70.79	$72.44	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $79.43 / $97.72	Professional		$43.65	$79.43	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $22.39 / $27.54	Professional	26	$12.30	$22.39	$27.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $56.23 / $70.79	Professional	TC	$29.51	$56.23	$70.79
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $50.12 / $81.28	Professional		$29.51	$50.12	$81.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $16.22 / $50.12	Professional	26	$9.12	$16.22	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $4.27 / $28.18 / $41.69	Professional	TC	$4.27	$28.18	$41.69
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $75.86 / $346.74	Facility		$43.65	$75.86	$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 $72.44 / $107.15 / $107.15	Facility	TC	$72.44	$107.15	$107.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $218.78	Professional		$32.36	$58.88	$218.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $15.14 / $87.10	Professional	26	$10.47	$15.14	$87.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.20 / $204.17	Professional	TC	$20.89	$30.20	$204.17
Midlands Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $75.86 / $107.15	Professional		$64.57	$75.86	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $23.99 / $33.11	Professional	26	$19.50	$23.99	$33.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $50.12 / $75.86	Professional	TC	$44.67	$50.12	$75.86
Midlands Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Facility	26	$36.31	$36.31	$36.31
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $74.13 / $74.13 / $74.13	Facility	TC	$74.13	$74.13	$74.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $67.61 / $83.18	Professional		$66.07	$67.61	$83.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $22.91 / $32.36	Professional	26	$21.38	$22.91	$32.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $46.77 / $58.88	Professional	TC	$43.65	$46.77	$58.88
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $1,148.15 / $1,659.59	Facility		$109.65	$1,148.15	$1,659.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $23.99 / $56.23	Professional		$10.00	$23.99	$56.23
United Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $239.88 / $323.59	Facility		$151.36	$239.88	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $38.02 / $70.79	Professional		$30.20	$38.02	$70.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.30 / $22.91	Professional	26	$10.00	$12.30	$22.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $25.12 / $46.77	Professional	TC	$20.42	$25.12	$46.77
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $66.07	Professional		$56.23	$56.23	$66.07
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $16.60 / $19.50	Professional	26	$16.60	$16.60	$19.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $39.81 / $46.77	Professional	TC	$39.81	$39.81	$46.77