Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $101.87 / $480.22 / $956.30	Facility		$101.87	$480.22	$956.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.23 / $55.55 / $89.77	Facility	26	$29.23	$55.55	$89.77
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $97.81 / $381.26 / $474.54	Facility	TC	$97.81	$381.26	$474.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.68 / $132.62 / $544.00	Professional		$26.68	$132.62	$544.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.69 / $27.99 / $98.16	Professional	26	$19.69	$27.99	$98.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.76 / $108.55 / $243.09	Professional	TC	$90.76	$108.55	$243.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.09 / $285.85 / $487.33	Professional		$133.09	$285.85	$487.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.05 / $51.62 / $80.86	Professional	26	$23.05	$51.62	$80.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.85 / $234.22 / $405.65	Professional	TC	$118.85	$234.22	$405.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $105.07 / $160.51 / $380.66	Professional		$105.07	$160.51	$380.66
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.41 / $31.88 / $100.54	Professional	26	$19.41	$31.88	$100.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $82.86 / $129.66 / $273.73	Professional	TC	$82.86	$129.66	$273.73
Medica Facility/Professional Facility Modifier Low / Median / High Price $160.68 / $275.47 / $535.91	Facility		$160.68	$275.47	$535.91
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $107.00 / $107.00 / $107.00	Facility	26	$107.00	$107.00	$107.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $442.03 / $442.03 / $502.34	Facility	TC	$442.03	$442.03	$502.34
Medica Facility/Professional Professional Modifier Low / Median / High Price $145.18 / $259.49 / $1,052.95	Professional		$145.18	$259.49	$1,052.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.54 / $45.38 / $237.75	Professional	26	$24.54	$45.38	$237.75
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $105.58 / $205.99 / $927.48	Professional	TC	$105.58	$205.99	$927.48
Midlands Facility/Professional Facility Modifier Low / Median / High Price $221.26 / $264.14 / $314.58	Facility		$221.26	$264.14	$314.58
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $172.44 / $172.44 / $172.44	Facility	TC	$172.44	$172.44	$172.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $175.16 / $264.14 / $314.58	Professional		$175.16	$264.14	$314.58
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,200.41 / $5,477.25 / $11,150.17	Facility		$1,200.41	$5,477.25	$11,150.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $21.25 / $106.74 / $207.30	Professional		$21.25	$106.74	$207.30
United Facility/Professional Professional Modifier Low / Median / High Price $124.76 / $217.77 / $308.50	Professional		$124.76	$217.77	$308.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.77 / $36.32 / $69.34	Professional	26	$23.77	$36.32	$69.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.41 / $182.92 / $297.45	Professional	TC	$101.41	$182.92	$297.45
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $172.38 / $218.20 / $256.60	Professional		$172.38	$218.20	$256.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $30.18 / $38.20 / $45.00	Professional	26	$30.18	$38.20	$45.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $142.12 / $179.90 / $211.70	Professional	TC	$142.12	$179.90	$211.70