Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $213.80 / $363.08	Facility		$58.88	$213.80	$363.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $11.48 / $16.98	Facility	26	$7.08	$11.48	$16.98
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $20.89 / $64.57 / $316.23	Facility	TC	$20.89	$64.57	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.55 / $36.31 / $154.88	Professional		$9.55	$36.31	$154.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $14.45 / $45.71	Professional	26	$7.59	$14.45	$45.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $24.55 / $123.03 / $165.96	Professional	50	$24.55	$123.03	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $38.90 / $125.89	Professional	TC	$19.95	$38.90	$125.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $107.15 / $112.20	Facility		$104.71	$107.15	$112.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $26.92 / $27.54	Facility	26	$25.70	$26.92	$27.54
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $79.43 / $81.28 / $83.18	Facility	TC	$79.43	$81.28	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $77.62 / $97.72	Professional		$40.74	$77.62	$97.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $19.05 / $23.99	Professional	26	$10.72	$19.05	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $58.88 / $74.13	Professional	TC	$29.51	$58.88	$74.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $48.98 / $125.89	Professional		$29.51	$48.98	$125.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $12.88 / $39.81	Professional	26	$7.76	$12.88	$39.81
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $34.67 / $89.13	Professional	TC	$21.88	$34.67	$89.13
Medica Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $83.18 / $346.74	Facility		$46.77	$83.18	$346.74
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $100.00 / $100.00	Facility	26	$26.92	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $109.65 / $128.82	Facility	TC	$100.00	$109.65	$128.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $56.23 / $208.93	Professional		$30.90	$56.23	$208.93
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $12.88 / $74.13	Professional	26	$8.71	$12.88	$74.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.90 / $177.83	Professional	TC	$20.89	$30.90	$177.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $69.18 / $83.18	Professional		$64.57	$69.18	$83.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $20.42 / $21.38	Professional	26	$16.60	$20.42	$21.38
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $52.48 / $61.66	Professional	TC	$45.71	$52.48	$61.66
Midlands Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Facility	26	$27.54	$27.54	$27.54
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	TC	$83.18	$83.18	$83.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $67.61 / $81.28	Professional		$60.26	$67.61	$81.28
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $19.50 / $25.12	Professional	26	$16.60	$19.50	$25.12
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $51.29 / $61.66	Professional	TC	$42.66	$51.29	$61.66
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $1,047.13 / $2,884.03	Facility		$602.56	$1,047.13	$2,884.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $25.70 / $56.23	Professional		$8.71	$25.70	$56.23
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $199.53 / $269.15	Facility		$114.82	$199.53	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $37.15 / $69.18	Professional		$28.84	$37.15	$69.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.72 / $19.50	Professional	26	$8.51	$10.72	$19.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $26.30 / $48.98	Professional	TC	$19.95	$26.30	$48.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $66.07	Professional		$56.23	$56.23	$66.07
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $14.45 / $16.98	Professional	26	$14.45	$14.45	$16.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $41.69 / $48.98	Professional	TC	$41.69	$41.69	$48.98