Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $55.87 / $179.57 / $542.79	Facility		$55.87	$179.57	$542.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.38 / $13.66 / $41.68	Facility	26	$7.38	$13.66	$41.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.11 / $62.35 / $269.48	Facility	TC	$31.11	$62.35	$269.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.86 / $34.10 / $175.00	Professional		$22.86	$34.10	$175.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.19 / $8.25 / $38.64	Professional	26	$7.19	$8.25	$38.64
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.46 / $15.75 / $99.85	Professional	52	$14.46	$15.75	$99.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $23.91 / $110.00	Professional	TC	$20.07	$23.91	$110.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.07 / $103.07 / $106.07	Facility		$100.07	$103.07	$106.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.49 / $30.37 / $31.26	Facility	26	$29.49	$30.37	$31.26
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $70.58 / $72.70 / $74.81	Facility	TC	$70.58	$72.70	$74.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.33 / $78.34 / $97.93	Professional		$32.33	$78.34	$97.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $17.84 / $23.00	Professional	26	$8.52	$17.84	$23.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.06 / $59.60 / $75.63	Professional	TC	$22.06	$59.60	$75.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $29.31 / $43.85 / $93.49	Professional		$29.31	$43.85	$93.49
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $11.80 / $26.14	Professional	26	$7.46	$11.80	$26.14
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.85 / $32.86 / $51.37	Professional	TC	$21.85	$32.86	$51.37
Medica Facility/Professional Facility Modifier Low / Median / High Price $40.22 / $66.34 / $239.94	Facility		$40.22	$66.34	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $100.00 / $100.00	Facility	26	$30.37	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $72.70 / $116.58 / $116.58	Facility	TC	$72.70	$116.58	$116.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.30 / $49.39 / $217.55	Professional		$30.30	$49.39	$217.55
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $10.71 / $59.45	Professional	26	$8.23	$10.71	$59.45
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.48 / $29.45 / $166.53	Professional	TC	$21.48	$29.45	$166.53
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $71.65 / $114.35	Facility		$50.00	$71.65	$114.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $31.26 / $44.64	Facility	26	$30.37	$31.26	$44.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $72.70 / $74.81 / $139.32	Facility	TC	$72.70	$74.81	$139.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $65.98 / $93.64	Professional		$46.00	$65.98	$93.64
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,679.19 / $1,679.19 / $1,679.19	Facility		$1,679.19	$1,679.19	$1,679.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.18 / $27.00 / $57.67	Professional		$8.18	$27.00	$57.67
United Facility/Professional Professional Modifier Low / Median / High Price $30.30 / $37.57 / $64.98	Professional		$30.30	$37.57	$64.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.71 / $17.23	Professional	26	$8.22	$10.71	$17.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.00 / $28.75 / $47.78	Professional	TC	$22.00	$28.75	$47.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $45.58 / $57.70 / $67.80	Professional		$45.58	$57.70	$67.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $10.82 / $13.70 / $16.10	Professional	26	$10.82	$13.70	$16.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $34.76 / $44.00 / $51.70	Professional	TC	$34.76	$44.00	$51.70