Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $56.43 / $190.01 / $381.90	Facility		$56.43	$190.01	$381.90
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.19 / $13.66 / $28.23	Facility	26	$7.19	$13.66	$28.23
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.20 / $247.35 / $587.96	Facility	TC	$36.20	$247.35	$587.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.25 / $34.54 / $152.00	Professional		$9.25	$34.54	$152.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.19 / $9.40 / $43.00	Professional	26	$7.19	$9.40	$43.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.89 / $214.03 / $727.32	Professional	50	$26.89	$214.03	$727.32
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.68 / $15.30 / $21.59	Professional	52	$13.68	$15.30	$21.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.90 / $25.67 / $105.00	Professional	TC	$21.90	$25.67	$105.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $96.81 / $99.71 / $102.62	Facility		$96.81	$99.71	$102.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.36 / $30.24 / $31.12	Facility	26	$29.36	$30.24	$31.12
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $67.45 / $69.48 / $71.51	Facility	TC	$67.45	$69.48	$71.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.99 / $79.12 / $100.05	Professional		$33.99	$79.12	$100.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $17.84 / $24.81	Professional	26	$8.52	$17.84	$24.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.32 / $61.28 / $76.59	Professional	TC	$23.32	$61.28	$76.59
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $29.60 / $45.83 / $84.24	Professional		$29.60	$45.83	$84.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.46 / $12.19 / $27.73	Professional	26	$7.46	$12.19	$27.73
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.14 / $33.29 / $49.60	Professional	TC	$22.14	$33.29	$49.60
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.74 / $72.14 / $239.94	Facility		$45.74	$72.14	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $30.24 / $100.00 / $100.00	Facility	26	$30.24	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $69.48 / $118.08 / $118.08	Facility	TC	$69.48	$118.08	$118.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.96 / $50.46 / $219.71	Professional		$30.96	$50.46	$219.71
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.28 / $67.70	Professional	26	$8.32	$11.28	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.76 / $30.04 / $168.70	Professional	TC	$21.76	$30.04	$168.70
Midlands Facility/Professional Facility Modifier Low / Median / High Price $54.00 / $72.58 / $115.47	Facility		$54.00	$72.58	$115.47
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $30.24 / $31.12 / $44.64	Facility	26	$30.24	$31.12	$44.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $69.48 / $71.51 / $141.12	Facility	TC	$69.48	$71.51	$141.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $66.63 / $100.05	Professional		$49.00	$66.63	$100.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.09 / $27.35 / $57.67	Professional		$8.09	$27.35	$57.67
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 $30.96 / $37.15 / $62.29	Professional		$30.96	$37.15	$62.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $10.68 / $19.88	Professional	26	$8.23	$10.68	$19.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.61 / $29.61 / $48.40	Professional	TC	$22.61	$29.61	$48.40
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $45.98 / $58.20 / $68.50	Professional		$45.98	$58.20	$68.50
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 $35.15 / $44.50 / $52.40	Professional	TC	$35.15	$44.50	$52.40