Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.34 / $207.89 / $439.06	Facility		$53.34	$207.89	$439.06
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.82 / $11.33 / $14.85	Facility	26	$7.82	$11.33	$14.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $16.54 / $137.60 / $339.18	Facility	TC	$16.54	$137.60	$339.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.14 / $24.23 / $110.00	Professional		$19.14	$24.23	$110.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.83 / $9.26 / $35.20	Professional	26	$7.83	$9.26	$35.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.66 / $15.27 / $33.82	Professional	TC	$10.66	$15.27	$33.82
Cigna Facility/Professional Facility Modifier Low / Median / High Price $62.48 / $64.34 / $66.23	Facility		$62.48	$64.34	$66.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.01 / $29.88 / $30.75	Facility	26	$29.01	$29.88	$30.75
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $33.47 / $34.47 / $35.47	Facility	TC	$33.47	$34.47	$35.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $20.91 / $59.73 / $74.66	Professional		$20.91	$59.73	$74.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.75 / $19.39 / $24.24	Professional	26	$8.75	$19.39	$24.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.99 / $38.04 / $50.42	Professional	TC	$12.99	$38.04	$50.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $25.58 / $35.75 / $95.72	Professional		$25.58	$35.75	$95.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $12.50 / $39.04	Professional	26	$8.84	$12.50	$39.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.91 / $23.24 / $36.31	Professional	TC	$16.91	$23.24	$36.31
Medica Facility/Professional Facility Modifier Low / Median / High Price $23.84 / $59.61 / $242.30	Facility		$23.84	$59.61	$242.30
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $29.88 / $70.00 / $70.00	Facility	26	$29.88	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $36.54 / $78.72 / $113.08	Facility	TC	$36.54	$78.72	$113.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $22.63 / $35.72 / $165.42	Professional		$22.63	$35.72	$165.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $13.31 / $55.28	Professional	26	$9.33	$13.31	$55.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $11.94 / $19.38 / $110.07	Professional	TC	$11.94	$19.38	$110.07
Midlands Facility/Professional Facility Modifier Low / Median / High Price $27.23 / $50.00 / $88.31	Facility		$27.23	$50.00	$88.31
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $29.88 / $30.75 / $46.80	Facility	26	$29.88	$30.75	$46.80
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $34.47 / $35.47 / $92.46	Facility	TC	$34.47	$35.47	$92.46
Midlands Facility/Professional Professional Modifier Low / Median / High Price $38.75 / $55.08 / $72.79	Professional		$38.75	$55.08	$72.79
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,053.55 / $5,104.34 / $10,391.02	Facility		$1,053.55	$5,104.34	$10,391.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.69 / $24.20 / $43.07	Professional		$8.69	$24.20	$43.07
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 $22.63 / $30.37 / $54.57	Professional		$22.63	$30.37	$54.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $11.26 / $18.75	Professional	26	$8.94	$11.26	$18.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $12.24 / $18.60 / $30.28	Professional	TC	$12.24	$18.60	$30.28
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $35.15 / $44.50 / $52.40	Professional		$35.15	$44.50	$52.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $14.80 / $17.50	Professional	26	$11.69	$14.80	$17.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $23.46 / $29.70 / $34.90	Professional	TC	$23.46	$29.70	$34.90