Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.53 / $166.92 / $275.16	Facility		$52.53	$166.92	$275.16
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.70 / $14.25 / $42.83	Facility	26	$7.70	$14.25	$42.83
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.28 / $41.16 / $91.56	Facility	TC	$23.28	$41.16	$91.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $32.42 / $147.00	Professional		$26.46	$32.42	$147.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $8.53 / $40.00	Professional	26	$7.33	$8.53	$40.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $23.87 / $51.04	Professional	TC	$19.14	$23.87	$51.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.70 / $92.39 / $95.08	Facility		$89.70	$92.39	$95.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.01 / $26.79 / $27.57	Facility	26	$26.01	$26.79	$27.57
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $63.69 / $65.59 / $67.51	Facility	TC	$63.69	$65.59	$67.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.96 / $76.02 / $95.02	Professional		$32.96	$76.02	$95.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.89 / $18.62 / $25.89	Professional	26	$8.89	$18.62	$25.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.07 / $57.20 / $71.75	Professional	TC	$24.07	$57.20	$71.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $28.50 / $45.76 / $100.21	Professional		$28.50	$45.76	$100.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $12.72 / $27.73	Professional	26	$7.78	$12.72	$27.73
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.72 / $32.54 / $59.87	Professional	TC	$20.72	$32.54	$59.87
Medica Facility/Professional Facility Modifier Low / Median / High Price $39.70 / $63.46 / $235.00	Facility		$39.70	$63.46	$235.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $26.79 / $100.00 / $100.00	Facility	26	$26.79	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $65.59 / $110.49 / $110.49	Facility	TC	$65.59	$110.49	$110.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.03 / $50.22 / $208.83	Professional		$29.03	$50.22	$208.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $11.17 / $82.56	Professional	26	$8.64	$11.17	$82.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.44 / $27.01 / $176.00	Professional	TC	$20.44	$27.01	$176.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $56.00 / $69.73 / $110.95	Facility		$56.00	$69.73	$110.95
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.79 / $27.57 / $46.62	Facility	26	$26.79	$27.57	$46.62
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $65.59 / $67.51 / $130.32	Facility	TC	$65.59	$67.51	$130.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $51.27 / $63.46 / $109.03	Professional		$51.27	$63.46	$109.03
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $90.88 / $90.88 / $90.88	Facility		$90.88	$90.88	$90.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.50 / $29.13 / $53.91	Professional		$8.50	$29.13	$53.91
United Facility/Professional Professional Modifier Low / Median / High Price $29.03 / $35.69 / $63.00	Professional		$29.03	$35.69	$63.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $10.56 / $17.26	Professional	26	$8.58	$10.56	$17.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.45 / $24.89 / $41.64	Professional	TC	$20.45	$24.89	$41.64
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $44.24 / $56.00 / $65.80	Professional		$44.24	$56.00	$65.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $11.30 / $14.30 / $16.80	Professional	26	$11.30	$14.30	$16.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $32.94 / $41.70 / $49.00	Professional	TC	$32.94	$41.70	$49.00