Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.37 / $207.00 / $361.45	Facility		$75.37	$207.00	$361.45
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $14.25 / $27.23	Facility	26	$7.50	$14.25	$27.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.41 / $63.83 / $311.00	Facility	TC	$21.41	$63.83	$311.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.70 / $35.56 / $130.19	Professional		$14.70	$35.56	$130.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.50 / $9.65 / $42.40	Professional	26	$7.50	$9.65	$42.40
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $124.32 / $124.32 / $228.00	Professional	50	$124.32	$124.32	$228.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.79 / $28.14 / $62.48	Professional	TC	$20.79	$28.14	$62.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.97 / $108.12 / $111.27	Facility		$104.97	$108.12	$111.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.91 / $26.69 / $27.46	Facility	26	$25.91	$26.69	$27.46
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $79.06 / $81.44 / $83.81	Facility	TC	$79.06	$81.44	$83.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.83 / $76.02 / $95.02	Professional		$33.83	$76.02	$95.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.89 / $18.62 / $23.27	Professional	26	$8.89	$18.62	$23.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.52 / $57.40 / $71.75	Professional	TC	$24.52	$57.40	$71.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $28.50 / $48.06 / $86.47	Professional		$28.50	$48.06	$86.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $12.72 / $29.79	Professional	26	$7.78	$12.72	$29.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.72 / $33.04 / $56.79	Professional	TC	$20.72	$33.04	$56.79
Medica Facility/Professional Facility Modifier Low / Median / High Price $42.03 / $69.73 / $239.94	Facility		$42.03	$69.73	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $26.69 / $100.00 / $100.00	Facility	26	$26.69	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $81.44 / $110.49 / $135.77	Facility	TC	$81.44	$110.49	$135.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $31.11 / $49.55 / $208.83	Professional		$31.11	$49.55	$208.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $11.17 / $74.30	Professional	26	$8.64	$11.17	$74.30
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.02 / $27.16 / $176.00	Professional	TC	$21.02	$27.16	$176.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $60.00 / $69.73 / $110.95	Facility		$60.00	$69.73	$110.95
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.69 / $27.46 / $46.62	Facility	26	$26.69	$27.46	$46.62
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $81.44 / $83.81 / $132.12	Facility	TC	$81.44	$83.81	$132.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $51.27 / $65.94 / $109.03	Professional		$51.27	$65.94	$109.03
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $557.35 / $1,452.89 / $2,957.68	Facility		$557.35	$1,452.89	$2,957.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.50 / $29.13 / $55.55	Professional		$8.50	$29.13	$55.55
United Facility/Professional Professional Modifier Low / Median / High Price $28.70 / $37.36 / $60.84	Professional		$28.70	$37.36	$60.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $10.55 / $18.00	Professional	26	$8.58	$10.55	$18.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.12 / $26.20 / $40.98	Professional	TC	$20.12	$26.20	$40.98
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