Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.25 / $200.25 / $399.94	Facility		$48.25	$200.25	$399.94
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.38 / $13.66 / $39.86	Facility	26	$7.38	$13.66	$39.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.04 / $78.14 / $275.75	Facility	TC	$28.04	$78.14	$275.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.80 / $30.81 / $124.00	Professional		$16.80	$30.81	$124.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.90 / $9.14 / $40.42	Professional	26	$6.90	$9.14	$40.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $21.52 / $51.92	Professional	TC	$18.21	$21.52	$51.92
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.87 / $92.57 / $95.26	Facility		$89.87	$92.57	$95.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.21 / $24.94 / $25.66	Facility	26	$24.21	$24.94	$25.66
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $65.66 / $67.63 / $69.59	Facility	TC	$65.66	$67.63	$69.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.66 / $68.26 / $85.33	Professional		$29.66	$68.26	$85.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.16 / $17.84 / $22.74	Professional	26	$8.16	$17.84	$22.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.13 / $50.42 / $63.03	Professional	TC	$21.13	$50.42	$63.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $25.62 / $40.98 / $73.61	Professional		$25.62	$40.98	$73.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $11.54 / $25.00	Professional	26	$7.46	$11.54	$25.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $18.17 / $29.03 / $49.31	Professional	TC	$18.17	$29.03	$49.31
Medica Facility/Professional Facility Modifier Low / Median / High Price $36.78 / $59.53 / $239.94	Facility		$36.78	$59.53	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $24.94 / $100.00 / $100.00	Facility	26	$24.94	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $67.63 / $100.00 / $100.00	Facility	TC	$67.63	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $26.61 / $45.64 / $187.12	Professional		$26.61	$45.64	$187.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.70 / $67.70	Professional	26	$8.22	$10.70	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $24.25 / $160.00	Professional	TC	$18.16	$24.25	$160.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $62.61 / $99.61	Facility		$50.00	$62.61	$99.61
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $24.94 / $25.66 / $44.64	Facility	26	$24.94	$25.66	$44.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $67.63 / $69.59 / $114.12	Facility	TC	$67.63	$69.59	$114.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $58.30 / $96.22	Professional		$46.00	$58.30	$96.22
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $224.75 / $6,011.78 / $10,383.98	Facility		$224.75	$6,011.78	$10,383.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.17 / $26.14 / $49.50	Professional		$8.17	$26.14	$49.50
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 $26.38 / $33.64 / $54.62	Professional		$26.38	$33.64	$54.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.70 / $16.48	Professional	26	$8.22	$10.70	$16.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $23.16 / $36.97	Professional	TC	$18.16	$23.16	$36.97
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 $10.82 / $13.70 / $16.10	Professional	26	$10.82	$13.70	$16.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $36.50 / $43.00	Professional	TC	$28.84	$36.50	$43.00