Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.70 / $207.40 / $450.72	Facility		$81.70	$207.40	$450.72
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $14.25 / $114.92	Facility	26	$7.50	$14.25	$114.92
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.51 / $123.14 / $368.00	Facility	TC	$28.51	$123.14	$368.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $11.21 / $39.54 / $175.00	Professional		$11.21	$39.54	$175.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $12.16 / $42.69	Professional	26	$7.63	$12.16	$42.69
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.85 / $125.66 / $249.48	Professional	50	$17.85	$125.66	$249.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.37 / $34.82 / $133.60	Professional	TC	$27.37	$34.82	$133.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $115.70 / $119.17 / $122.64	Facility		$115.70	$119.17	$122.64
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.16 / $26.94 / $27.73	Facility	26	$26.16	$26.94	$27.73
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $89.54 / $92.23 / $94.91	Facility	TC	$89.54	$92.23	$94.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.19 / $96.19 / $120.23	Professional		$34.19	$96.19	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.89 / $18.62 / $25.89	Professional	26	$8.89	$18.62	$25.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.35 / $75.27 / $96.96	Professional	TC	$25.35	$75.27	$96.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $35.88 / $53.84 / $105.03	Professional		$35.88	$53.84	$105.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $12.72 / $29.15	Professional	26	$7.78	$12.72	$29.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.10 / $41.89 / $64.34	Professional	TC	$28.10	$41.89	$64.34
Medica Facility/Professional Facility Modifier Low / Median / High Price $52.55 / $88.24 / $239.94	Facility		$52.55	$88.24	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $26.94 / $100.00 / $100.00	Facility	26	$26.94	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $92.23 / $149.85 / $149.85	Facility	TC	$92.23	$149.85	$149.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $35.90 / $57.00 / $263.06	Professional		$35.90	$57.00	$263.06
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $11.24 / $67.70	Professional	26	$8.64	$11.24	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.95 / $36.11 / $209.88	Professional	TC	$25.95	$36.11	$209.88
Midlands Facility/Professional Facility Modifier Low / Median / High Price $57.00 / $88.24 / $140.38	Facility		$57.00	$88.24	$140.38
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.94 / $27.73 / $46.62	Facility	26	$26.94	$27.73	$46.62
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $92.23 / $94.91 / $177.18	Facility	TC	$92.23	$94.91	$177.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $80.20 / $107.45	Professional		$52.00	$80.20	$107.45
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $435.74 / $2,145.06 / $4,366.75	Facility		$435.74	$2,145.06	$4,366.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $35.24 / $71.33	Professional		$8.51	$35.24	$71.33
United Facility/Professional Professional Modifier Low / Median / High Price $34.94 / $45.79 / $76.26	Professional		$34.94	$45.79	$76.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $10.83 / $23.53	Professional	26	$8.58	$10.83	$23.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.95 / $34.15 / $55.67	Professional	TC	$25.95	$34.15	$55.67
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $55.93 / $70.80 / $83.30	Professional		$55.93	$70.80	$83.30
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 $44.64 / $56.50 / $66.50	Professional	TC	$44.64	$56.50	$66.50