Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.19 / $168.30 / $533.78	Facility		$68.19	$168.30	$533.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.91 / $18.32 / $18.32	Facility	26	$9.91	$18.32	$18.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $40.40 / $115.56 / $535.59	Facility	TC	$40.40	$115.56	$535.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.31 / $41.60 / $168.02	Professional		$35.31	$41.60	$168.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $11.08 / $43.12	Professional	26	$9.65	$11.08	$43.12
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.89 / $77.44 / $403.48	Professional	52	$16.89	$77.44	$403.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $28.94 / $77.44	Professional	TC	$25.57	$28.94	$77.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.61 / $159.25 / $163.89	Facility		$154.61	$159.25	$163.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.99 / $47.37 / $48.75	Facility	26	$45.99	$47.37	$48.75
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $108.62 / $111.88 / $115.14	Facility	TC	$108.62	$111.88	$115.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.39 / $96.19 / $120.23	Professional		$39.39	$96.19	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.73 / $24.05 / $30.06	Professional	26	$10.73	$24.05	$30.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.11 / $72.14 / $90.18	Professional	TC	$28.11	$72.14	$90.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.63 / $56.27 / $161.28	Professional		$40.63	$56.27	$161.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.91 / $15.33 / $47.16	Professional	26	$10.91	$15.33	$47.16
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.03 / $40.94 / $102.63	Professional	TC	$30.03	$40.94	$102.63
Medica Facility/Professional Facility Modifier Low / Median / High Price $46.98 / $80.50 / $319.62	Facility		$46.98	$80.50	$319.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $47.37 / $70.00 / $70.00	Facility	26	$47.37	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $111.88 / $139.28 / $261.77	Facility	TC	$111.88	$139.28	$261.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.40 / $56.59 / $186.02	Professional		$38.40	$56.59	$186.02
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $14.38 / $68.20	Professional	26	$11.04	$14.38	$68.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $33.86 / $196.89	Professional	TC	$26.01	$33.86	$196.89
Midlands Facility/Professional Facility Modifier Low / Median / High Price $72.95 / $88.24 / $159.25	Facility		$72.95	$88.24	$159.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $47.37 / $48.75 / $60.06	Facility	26	$47.37	$48.75	$60.06
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $111.88 / $115.14 / $164.52	Facility	TC	$111.88	$115.14	$164.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $72.95 / $85.10 / $138.72	Professional		$72.95	$85.10	$138.72
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 $10.72 / $32.15 / $68.63	Professional		$10.72	$32.15	$68.63
United Facility/Professional Professional Modifier Low / Median / High Price $37.47 / $48.25 / $86.25	Professional		$37.47	$48.25	$86.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $13.86 / $23.28	Professional	26	$11.04	$13.86	$23.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $32.51 / $52.98	Professional	TC	$26.01	$32.51	$52.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $55.93 / $70.80 / $83.30	Professional		$55.93	$70.80	$83.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.46 / $18.30 / $21.50	Professional	26	$14.46	$18.30	$21.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $41.48 / $52.50 / $61.80	Professional	TC	$41.48	$52.50	$61.80