Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.75 / $183.21 / $311.52	Facility		$51.75	$183.21	$311.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.82 / $11.34 / $14.85	Facility	26	$7.82	$11.34	$14.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.42 / $105.29 / $311.52	Facility	TC	$21.42	$105.29	$311.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.40 / $31.41 / $128.00	Professional		$25.40	$31.41	$128.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.86 / $9.33 / $36.53	Professional	26	$7.86	$9.33	$36.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.91 / $21.47 / $69.52	Professional	TC	$17.91	$21.47	$69.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.67 / $110.90 / $114.13	Facility		$107.67	$110.90	$114.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.36 / $37.45 / $38.54	Facility	26	$36.36	$37.45	$38.54
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $71.31 / $73.45 / $75.59	Facility	TC	$71.31	$73.45	$75.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.47 / $69.81 / $87.27	Professional		$28.47	$69.81	$87.27
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 $18.39 / $50.42 / $63.03	Professional	TC	$18.39	$50.42	$63.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $29.47 / $40.95 / $91.43	Professional		$29.47	$40.95	$91.43
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.84 / $11.70 / $35.95	Professional	26	$8.84	$11.70	$35.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.63 / $27.95 / $42.30	Professional	TC	$20.63	$27.95	$42.30
Medica Facility/Professional Facility Modifier Low / Median / High Price $32.76 / $64.04 / $268.11	Facility		$32.76	$64.04	$268.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $37.45 / $70.00 / $70.00	Facility	26	$37.45	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $73.45 / $96.88 / $96.88	Facility	TC	$73.45	$96.88	$96.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $27.16 / $41.43 / $193.62	Professional		$27.16	$41.43	$193.62
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.99 / $11.71 / $55.28	Professional	26	$8.99	$11.71	$55.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $17.94 / $23.65 / $138.27	Professional	TC	$17.94	$23.65	$138.27
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.25 / $64.04 / $114.13	Facility		$50.25	$64.04	$114.13
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $37.45 / $38.54 / $48.60	Facility	26	$37.45	$38.54	$48.60
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $73.45 / $75.59 / $115.92	Facility	TC	$73.45	$75.59	$115.92
Midlands Facility/Professional Professional Modifier Low / Median / High Price $50.25 / $63.99 / $99.69	Professional		$50.25	$63.99	$99.69
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $401.13 / $2,202.73 / $4,484.13	Facility		$401.13	$2,202.73	$4,484.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.74 / $21.86 / $50.16	Professional		$8.74	$21.86	$50.16
United Facility/Professional Professional Modifier Low / Median / High Price $27.10 / $34.74 / $59.18	Professional		$27.10	$34.74	$59.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.08 / $11.64 / $26.65	Professional	26	$9.08	$11.64	$26.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $22.72 / $39.14	Professional	TC	$18.16	$22.72	$39.14
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $40.61 / $51.40 / $60.50	Professional		$40.61	$51.40	$60.50
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 $28.84 / $36.50 / $43.00	Professional	TC	$28.84	$36.50	$43.00