Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.45 / $184.27 / $410.22	Facility		$77.45	$184.27	$410.22
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.65 / $14.22 / $18.32	Facility	26	$9.65	$14.22	$18.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.84 / $210.77 / $311.52	Facility	TC	$34.84	$210.77	$311.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.63 / $43.83 / $170.86	Professional		$10.63	$43.83	$170.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $11.87 / $43.12	Professional	26	$9.65	$11.87	$43.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.60 / $34.84 / $107.36	Professional	TC	$29.60	$34.84	$107.36
Cigna Facility/Professional Facility Modifier Low / Median / High Price $161.58 / $166.43 / $171.27	Facility		$161.58	$166.43	$171.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.60 / $45.94 / $47.28	Facility	26	$44.60	$45.94	$47.28
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $116.99 / $120.50 / $124.01	Facility	TC	$116.99	$120.50	$124.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $42.65 / $111.70 / $139.63	Professional		$42.65	$111.70	$139.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.73 / $24.05 / $30.06	Professional	26	$10.73	$24.05	$30.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.27 / $87.65 / $109.57	Professional	TC	$30.27	$87.65	$109.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.82 / $64.67 / $133.87	Professional		$46.82	$64.67	$133.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.33 / $47.37	Professional	26	$10.96	$15.33	$47.37
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.89 / $49.35 / $93.83	Professional	TC	$35.89	$49.35	$93.83
Medica Facility/Professional Facility Modifier Low / Median / High Price $49.06 / $97.20 / $268.11	Facility		$49.06	$97.20	$268.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $45.94 / $70.00 / $70.00	Facility	26	$45.94	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $78.56 / $168.01 / $232.05	Facility	TC	$78.56	$168.01	$232.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $41.96 / $64.16 / $277.30	Professional		$41.96	$64.16	$277.30
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.11 / $14.38 / $68.20	Professional	26	$11.11	$14.38	$68.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $29.46 / $40.26 / $233.75	Professional	TC	$29.46	$40.26	$233.75
Midlands Facility/Professional Facility Modifier Low / Median / High Price $76.18 / $101.77 / $166.43	Facility		$76.18	$101.77	$166.43
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $45.94 / $47.28 / $60.06	Facility	26	$45.94	$47.28	$60.06
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $120.50 / $124.01 / $198.78	Facility	TC	$120.50	$124.01	$198.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $76.18 / $95.24 / $144.85	Professional		$76.18	$95.24	$144.85
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $526.62 / $4,086.60 / $8,319.17	Facility		$526.62	$4,086.60	$8,319.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $39.35 / $80.09	Professional		$10.72	$39.35	$80.09
United Facility/Professional Professional Modifier Low / Median / High Price $41.96 / $50.35 / $84.42	Professional		$41.96	$50.35	$84.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $13.80 / $23.14	Professional	26	$11.04	$13.80	$23.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.92 / $37.13 / $63.01	Professional	TC	$30.92	$37.13	$63.01
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $64.45 / $81.59 / $96.10	Professional		$64.45	$81.59	$96.10
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 $50.09 / $63.40 / $74.59	Professional	TC	$50.09	$63.40	$74.59