Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.55 / $225.13 / $470.56	Facility		$62.55	$225.13	$470.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $14.25 / $43.49	Facility	26	$7.50	$14.25	$43.49
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.01 / $173.70 / $546.28	Facility	TC	$25.01	$173.70	$546.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.53 / $36.38 / $137.22	Professional		$9.53	$36.38	$137.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.50 / $11.28 / $44.00	Professional	26	$7.50	$11.28	$44.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $95.00 / $113.52 / $113.52	Professional	50	$95.00	$113.52	$113.52
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.65 / $16.32 / $23.28	Professional	52	$14.65	$16.32	$23.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.77 / $29.03 / $110.00	Professional	TC	$23.77	$29.03	$110.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $103.68 / $106.79 / $109.90	Facility		$103.68	$106.79	$109.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.12 / $26.90 / $27.69	Facility	26	$26.12	$26.90	$27.69
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $77.56 / $79.90 / $82.22	Facility	TC	$77.56	$79.90	$82.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.72 / $84.55 / $105.69	Professional		$33.72	$84.55	$105.69
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 $23.74 / $65.93 / $82.42	Professional	TC	$23.74	$65.93	$82.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $46.94 / $80.31	Professional		$31.62	$46.94	$80.31
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $12.02 / $32.79	Professional	26	$7.78	$12.02	$32.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.84 / $35.76 / $53.98	Professional	TC	$23.84	$35.76	$53.98
Medica Facility/Professional Facility Modifier Low / Median / High Price $49.31 / $82.83 / $335.20	Facility		$49.31	$82.83	$335.20
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $26.90 / $100.00 / $100.00	Facility	26	$26.90	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $79.90 / $127.16 / $153.24	Facility	TC	$79.90	$127.16	$153.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $52.65 / $237.03	Professional		$32.29	$52.65	$237.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $11.59 / $71.00	Professional	26	$8.64	$11.59	$71.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.47 / $31.34 / $183.85	Professional	TC	$23.47	$31.34	$183.85
Midlands Facility/Professional Facility Modifier Low / Median / High Price $56.00 / $77.56 / $123.41	Facility		$56.00	$77.56	$123.41
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.90 / $27.69 / $46.62	Facility	26	$26.90	$27.69	$46.62
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $79.90 / $82.22 / $151.91	Facility	TC	$79.90	$82.22	$151.91
Midlands Facility/Professional Professional Modifier Low / Median / High Price $51.00 / $71.19 / $101.35	Professional		$51.00	$71.19	$101.35
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,262.89 / $9,828.84 / $20,008.75	Facility		$1,262.89	$9,828.84	$20,008.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.41 / $29.75 / $62.08	Professional		$8.41	$29.75	$62.08
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 $32.29 / $41.19 / $69.28	Professional		$32.29	$41.19	$69.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $10.56 / $18.00	Professional	26	$8.58	$10.56	$18.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $28.46 / $48.32	Professional	TC	$23.72	$28.46	$48.32
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $49.14 / $62.20 / $73.20	Professional		$49.14	$62.20	$73.20
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 $37.92 / $48.00 / $56.40	Professional	TC	$37.92	$48.00	$56.40