Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.94 / $495.80 / $668.74	Facility		$75.94	$495.80	$668.74
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.01 / $51.52 / $100.52	Facility	26	$28.01	$51.52	$100.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.34 / $78.63 / $229.00	Professional		$49.34	$78.63	$229.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.12 / $31.35 / $179.30	Professional	26	$27.12	$31.35	$179.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.08 / $33.43 / $175.56	Professional	TC	$23.08	$33.43	$175.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $628.46 / $647.30 / $666.17	Facility		$628.46	$647.30	$666.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.63 / $104.68 / $107.73	Facility	26	$101.63	$104.68	$107.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.12 / $145.32 / $410.76	Professional		$85.12	$145.32	$410.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.22 / $69.04 / $102.00	Professional	26	$37.22	$69.04	$102.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.77 / $69.66 / $346.43	Professional	TC	$40.77	$69.66	$346.43
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.57 / $113.48 / $376.89	Professional		$53.57	$113.48	$376.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.23 / $45.60 / $149.81	Professional	26	$28.23	$45.60	$149.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $46.73 / $252.38	Professional	TC	$24.69	$46.73	$252.38
Medica Facility/Professional Facility Modifier Low / Median / High Price $52.08 / $168.41 / $465.63	Facility		$52.08	$168.41	$465.63
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $104.68 / $261.98 / $261.98	Facility	26	$104.68	$261.98	$261.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.04 / $124.03 / $947.00	Professional		$60.04	$124.03	$947.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $31.64 / $40.61 / $368.00	Professional	26	$31.64	$40.61	$368.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.73 / $47.64 / $758.00	Professional	TC	$25.73	$47.64	$758.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $109.72 / $132.84 / $492.62	Facility		$109.72	$132.84	$492.62
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $104.68 / $107.73 / $167.64	Facility	26	$104.68	$107.73	$167.64
Midlands Facility/Professional Professional Modifier Low / Median / High Price $109.72 / $132.84 / $318.11	Professional		$109.72	$132.84	$318.11
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $7,370.23 / $25,961.65 / $52,850.51	Facility		$7,370.23	$25,961.65	$52,850.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.34 / $53.64 / $106.69	Professional		$29.34	$53.64	$106.69
United Facility/Professional Professional Modifier Low / Median / High Price $58.47 / $71.06 / $183.00	Professional		$58.47	$71.06	$183.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.19 / $38.33 / $71.69	Professional	26	$31.19	$38.33	$71.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $31.18 / $154.66	Professional	TC	$24.69	$31.18	$154.66
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $82.87 / $104.90 / $128.00	Professional		$82.87	$104.90	$128.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.19 / $53.40 / $62.80	Professional	26	$42.19	$53.40	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $40.76 / $51.60 / $60.70	Professional	TC	$40.76	$51.60	$60.70