Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.52 / $251.28 / $577.71	Facility		$70.52	$251.28	$577.71
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 $38.63 / $323.95 / $413.45	Facility	TC	$38.63	$323.95	$413.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.11 / $44.44 / $167.00	Professional		$34.11	$44.44	$167.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $11.43 / $48.40	Professional	26	$9.65	$11.43	$48.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.09 / $32.61 / $81.00	Professional	TC	$25.09	$32.61	$81.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $115.61 / $119.08 / $122.55	Facility		$115.61	$119.08	$122.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.27 / $37.36 / $38.45	Facility	26	$36.27	$37.36	$38.45
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $79.34 / $81.72 / $84.10	Facility	TC	$79.34	$81.72	$84.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $92.31 / $115.39	Professional		$40.00	$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 $28.66 / $68.26 / $85.33	Professional	TC	$28.66	$68.26	$85.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.65 / $57.38 / $98.35	Professional		$34.65	$57.38	$98.35
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.96 / $16.14 / $33.90	Professional	26	$9.96	$16.14	$33.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $37.84 / $49.57	Professional	TC	$24.69	$37.84	$49.57
Medica Facility/Professional Facility Modifier Low / Median / High Price $53.24 / $85.88 / $323.83	Facility		$53.24	$85.88	$323.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $37.36 / $100.00 / $100.00	Facility	26	$37.36	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $81.72 / $131.69 / $310.31	Facility	TC	$81.72	$131.69	$310.31
Medica Facility/Professional Professional Modifier Low / Median / High Price $36.86 / $60.97 / $256.38	Professional		$36.86	$60.97	$256.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $14.38 / $82.56	Professional	26	$11.04	$14.38	$82.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.37 / $32.47 / $211.00	Professional	TC	$24.37	$32.47	$211.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $70.00 / $84.68 / $134.72	Facility		$70.00	$84.68	$134.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $37.36 / $38.45 / $60.06	Facility	26	$37.36	$38.45	$60.06
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $81.72 / $84.10 / $157.32	Facility	TC	$81.72	$84.10	$157.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $62.40 / $77.92 / $129.56	Professional		$62.40	$77.92	$129.56
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $100.50 / $761.46 / $1,550.12	Facility		$100.50	$761.46	$1,550.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $30.78 / $67.72	Professional		$10.72	$30.78	$67.72
United Facility/Professional Professional Modifier Low / Median / High Price $35.40 / $42.49 / $71.53	Professional		$35.40	$42.49	$71.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $13.25 / $22.21	Professional	26	$11.04	$13.25	$22.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.37 / $31.07 / $52.27	Professional	TC	$24.37	$31.07	$52.27
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