Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.70 / $179.85 / $416.50	Facility		$58.70	$179.85	$416.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.97 / $14.85 / $14.85	Facility	26	$7.97	$14.85	$14.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.76 / $81.01 / $273.51	Facility	TC	$23.76	$81.01	$273.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.75 / $35.20 / $162.00	Professional		$17.75	$35.20	$162.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.82 / $9.72 / $38.22	Professional	26	$7.82	$9.72	$38.22
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $135.00 / $135.00 / $135.00	Professional	50	$135.00	$135.00	$135.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $25.80 / $80.08	Professional	TC	$20.96	$25.80	$80.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $103.67 / $106.78 / $109.89	Facility		$103.67	$106.78	$109.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.77 / $31.69 / $32.61	Facility	26	$30.77	$31.69	$32.61
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $72.90 / $75.09 / $77.27	Facility	TC	$72.90	$75.09	$77.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.50 / $83.00 / $103.75	Professional		$33.50	$83.00	$103.75
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 $23.08 / $63.61 / $79.51	Professional	TC	$23.08	$63.61	$79.51
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $34.99 / $48.57 / $140.40	Professional		$34.99	$48.57	$140.40
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.88 / $12.50 / $40.22	Professional	26	$8.88	$12.50	$40.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.42 / $36.08 / $83.99	Professional	TC	$26.42	$36.08	$83.99
Medica Facility/Professional Facility Modifier Low / Median / High Price $38.45 / $69.31 / $264.62	Facility		$38.45	$69.31	$264.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $31.69 / $70.00 / $70.00	Facility	26	$31.69	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $75.09 / $122.62 / $122.62	Facility	TC	$75.09	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.01 / $49.01 / $152.50	Professional		$32.01	$49.01	$152.50
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $11.64 / $55.28	Professional	26	$8.94	$11.64	$55.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.48 / $30.04 / $170.86	Professional	TC	$22.48	$30.04	$170.86
Midlands Facility/Professional Facility Modifier Low / Median / High Price $59.84 / $76.14 / $121.14	Facility		$59.84	$76.14	$121.14
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $31.69 / $32.61 / $48.60	Facility	26	$31.69	$32.61	$48.60
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $75.09 / $77.27 / $144.72	Facility	TC	$75.09	$77.27	$144.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.93 / $73.83 / $113.55	Professional		$57.93	$73.83	$113.55
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $110.38 / $1,836.97 / $3,172.93	Facility		$110.38	$1,836.97	$3,172.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.84 / $32.38 / $59.96	Professional		$8.84	$32.38	$59.96
United Facility/Professional Professional Modifier Low / Median / High Price $32.01 / $38.40 / $65.06	Professional		$32.01	$38.40	$65.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.94 / $11.11 / $18.75	Professional	26	$8.94	$11.11	$18.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.07 / $27.68 / $46.97	Professional	TC	$23.07	$27.68	$46.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $48.27 / $61.10 / $71.90	Professional		$48.27	$61.10	$71.90
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 $36.50 / $46.20 / $54.40	Professional	TC	$36.50	$46.20	$54.40