Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $59.79 / $194.94 / $413.40	Facility		$59.79	$194.94	$413.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.90 / $13.10 / $41.02	Facility	26	$6.90	$13.10	$41.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.89 / $64.90 / $267.64	Facility	TC	$25.89	$64.90	$267.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.08 / $30.71 / $134.00	Professional		$12.08	$30.71	$134.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.90 / $9.02 / $41.83	Professional	26	$6.90	$9.02	$41.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $21.58 / $46.26	Professional	TC	$18.21	$21.58	$46.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $86.42 / $89.01 / $91.61	Facility		$86.42	$89.01	$91.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.39 / $25.12 / $25.85	Facility	26	$24.39	$25.12	$25.85
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $62.03 / $63.89 / $65.75	Facility	TC	$62.03	$63.89	$65.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.66 / $68.26 / $95.59	Professional		$29.66	$68.26	$95.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.21 / $17.07 / $23.74	Professional	26	$8.21	$17.07	$23.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.45 / $51.20 / $69.23	Professional	TC	$21.45	$51.20	$69.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $25.62 / $41.62 / $91.10	Professional		$25.62	$41.62	$91.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.17 / $11.72 / $26.71	Professional	26	$7.17	$11.72	$26.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.45 / $29.39 / $50.18	Professional	TC	$18.45	$29.39	$50.18
Medica Facility/Professional Facility Modifier Low / Median / High Price $39.11 / $62.61 / $235.00	Facility		$39.11	$62.61	$235.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $100.00 / $100.00	Facility	26	$25.12	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $63.89 / $100.00 / $145.54	Facility	TC	$63.89	$100.00	$145.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $26.70 / $46.19 / $187.12	Professional		$26.70	$46.19	$187.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.71 / $64.39	Professional	26	$8.22	$10.71	$64.39
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $24.42 / $161.00	Professional	TC	$18.48	$24.42	$161.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $51.00 / $62.61 / $99.61	Facility		$51.00	$62.61	$99.61
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $25.85 / $42.84	Facility	26	$25.12	$25.85	$42.84
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $63.89 / $65.75 / $115.92	Facility	TC	$63.89	$65.75	$115.92
Midlands Facility/Professional Professional Modifier Low / Median / High Price $47.00 / $56.98 / $97.48	Professional		$47.00	$56.98	$97.48
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $139.03 / $1,366.54 / $1,997.25	Facility		$139.03	$1,366.54	$1,997.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $7.75 / $26.14 / $48.96	Professional		$7.75	$26.14	$48.96
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 $26.70 / $32.04 / $56.93	Professional		$26.70	$32.04	$56.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.28 / $17.23	Professional	26	$8.22	$10.28	$17.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.48 / $23.10 / $37.64	Professional	TC	$18.48	$23.10	$37.64
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $39.65 / $50.20 / $59.10	Professional		$39.65	$50.20	$59.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $10.35 / $13.10 / $15.40	Professional	26	$10.35	$13.10	$15.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $29.31 / $37.10 / $43.70	Professional	TC	$29.31	$37.10	$43.70