Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.63 / $215.20 / $443.41	Facility		$79.63	$215.20	$443.41
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.50 / $14.25 / $26.67	Facility	26	$7.50	$14.25	$26.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.17 / $193.56 / $544.82	Facility	TC	$37.17	$193.56	$544.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.49 / $36.92 / $140.00	Professional		$12.49	$36.92	$140.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.52 / $12.52 / $41.36	Professional	26	$7.52	$12.52	$41.36
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $13.50 / $92.72 / $223.10	Professional	50	$13.50	$92.72	$223.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.40 / $34.86 / $115.26	Professional	TC	$24.40	$34.86	$115.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $100.10 / $103.10 / $106.11	Facility		$100.10	$103.10	$106.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.91 / $26.69 / $27.46	Facility	26	$25.91	$26.69	$27.46
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $74.19 / $76.42 / $78.64	Facility	TC	$74.19	$76.42	$78.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.72 / $86.88 / $108.60	Professional		$33.72	$86.88	$108.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.89 / $18.62 / $25.89	Professional	26	$8.89	$18.62	$25.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.74 / $68.26 / $85.33	Professional	TC	$23.74	$68.26	$85.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $32.47 / $48.65 / $91.50	Professional		$32.47	$48.65	$91.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $12.72 / $29.15	Professional	26	$7.78	$12.72	$29.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $37.17 / $53.71	Professional	TC	$24.69	$37.17	$53.71
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.55 / $79.70 / $268.11	Facility		$45.55	$79.70	$268.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $26.69 / $100.00 / $100.00	Facility	26	$26.69	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $76.42 / $131.69 / $210.54	Facility	TC	$76.42	$131.69	$210.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $52.97 / $234.86	Professional		$32.29	$52.97	$234.86
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.64 / $11.27 / $67.70	Professional	26	$8.64	$11.27	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.29 / $31.41 / $181.68	Professional	TC	$23.29	$31.41	$181.68
Midlands Facility/Professional Facility Modifier Low / Median / High Price $55.00 / $79.70 / $126.81	Facility		$55.00	$79.70	$126.81
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.69 / $27.46 / $46.62	Facility	26	$26.69	$27.46	$46.62
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $76.42 / $78.64 / $155.52	Facility	TC	$76.42	$78.64	$155.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $72.48 / $101.35	Professional		$50.00	$72.48	$101.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $30.44 / $63.71	Professional		$8.51	$30.44	$63.71
United Facility/Professional Facility Modifier Low / Median / High Price $107.74 / $109.22 / $161.80	Facility		$107.74	$109.22	$161.80
United Facility/Professional Professional Modifier Low / Median / High Price $32.29 / $38.76 / $65.00	Professional		$32.29	$38.76	$65.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.58 / $10.73 / $18.39	Professional	26	$8.58	$10.73	$18.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.53 / $28.93 / $50.88	Professional	TC	$22.53	$28.93	$50.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $50.48 / $63.90 / $75.20	Professional		$50.48	$63.90	$75.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $11.30 / $14.30 / $16.80	Professional	26	$11.30	$14.30	$16.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $39.26 / $49.70 / $58.40	Professional	TC	$39.26	$49.70	$58.40