Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $51.52 / $98.00 / $338.55	Facility		$51.52	$98.00	$338.55
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.33 / $13.66 / $41.02	Facility	26	$7.33	$13.66	$41.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.44 / $56.66 / $91.29	Facility	TC	$30.44	$56.66	$91.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.43 / $32.47 / $211.50	Professional		$21.43	$32.47	$211.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $8.22 / $44.80	Professional	26	$7.03	$8.22	$44.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $80.48 / $80.48 / $80.48	Professional	50	$80.48	$80.48	$80.48
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.29 / $14.83 / $174.20	Professional	52	$13.29	$14.83	$174.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.02 / $21.90 / $113.60	Professional	TC	$18.02	$21.90	$113.60
Cigna Facility/Professional Facility Modifier Low / Median / High Price $86.28 / $88.87 / $91.46	Facility		$86.28	$88.87	$91.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.01 / $25.76 / $26.51	Facility	26	$25.01	$25.76	$26.51
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $61.28 / $63.12 / $64.95	Facility	TC	$61.28	$63.12	$64.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $71.98 / $91.14	Professional		$31.62	$71.98	$91.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $17.84 / $22.34	Professional	26	$8.52	$17.84	$22.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.06 / $53.40 / $68.84	Professional	TC	$22.06	$53.40	$68.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $27.33 / $42.74 / $80.45	Professional		$27.33	$42.74	$80.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $11.80 / $23.99	Professional	26	$7.46	$11.80	$23.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.87 / $29.77 / $41.54	Professional	TC	$19.87	$29.77	$41.54
Medica Facility/Professional Facility Modifier Low / Median / High Price $37.71 / $61.48 / $289.80	Facility		$37.71	$61.48	$289.80
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $25.76 / $100.00 / $100.00	Facility	26	$25.76	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $63.12 / $105.96 / $105.96	Facility	TC	$63.12	$105.96	$105.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $28.01 / $45.81 / $200.17	Professional		$28.01	$45.81	$200.17
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.70 / $61.09	Professional	26	$8.22	$10.70	$61.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.80 / $26.42 / $154.00	Professional	TC	$18.80	$26.42	$154.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $66.90 / $106.44	Facility		$50.00	$66.90	$106.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $25.76 / $26.51 / $44.64	Facility	26	$25.76	$26.51	$44.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $63.12 / $64.95 / $126.72	Facility	TC	$63.12	$64.95	$126.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $61.48 / $93.64	Professional		$46.00	$61.48	$93.64
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $109.17 / $109.17 / $109.17	Facility		$109.17	$109.17	$109.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.09 / $24.26 / $52.76	Professional		$8.09	$24.26	$52.76
United Facility/Professional Facility Modifier Low / Median / High Price $147.11 / $151.31 / $217.94	Facility		$147.11	$151.31	$217.94
United Facility/Professional Professional Modifier Low / Median / High Price $28.01 / $36.47 / $60.80	Professional		$28.01	$36.47	$60.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.40 / $16.54	Professional	26	$8.22	$10.40	$16.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.80 / $23.75 / $40.31	Professional	TC	$18.80	$23.75	$40.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $42.42 / $53.70 / $63.10	Professional		$42.42	$53.70	$63.10
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 $31.60 / $40.00 / $47.00	Professional	TC	$31.60	$40.00	$47.00