Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $19.50 / $22.91	Facility	26	$8.91	$19.50	$22.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $93.33 / $436.52	Facility	TC	$30.20	$93.33	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $58.88 / $229.09	Professional		$19.05	$58.88	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $22.39 / $77.62	Professional	26	$10.00	$22.39	$77.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $41.69 / $123.03 / $275.42	Professional	50	$41.69	$123.03	$275.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	52	$43.65	$43.65	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $56.23 / $229.09	Professional	TC	$28.84	$56.23	$229.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $38.02 / $38.90	Facility	26	$36.31	$38.02	$38.90
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $102.33 / $104.71	Facility	TC	$100.00	$102.33	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $112.20 / $141.25	Professional		$53.70	$112.20	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $25.12 / $31.62	Professional	26	$13.80	$25.12	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $87.10 / $109.65	Professional	TC	$38.90	$87.10	$109.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $64.57 / $154.88	Professional		$42.66	$64.57	$154.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $16.60 / $56.23	Professional	26	$10.23	$16.60	$56.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $46.77 / $97.72	Professional	TC	$31.62	$46.77	$97.72
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $100.00 / $100.00	Facility	26	$38.02	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $102.33 / $165.96 / $194.98	Facility	TC	$102.33	$165.96	$194.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $74.13 / $295.12	Professional		$38.90	$74.13	$295.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $17.38 / $87.10	Professional	26	$10.96	$17.38	$87.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $41.69 / $229.09	Professional	TC	$27.54	$41.69	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $91.20 / $117.49	Professional		$75.86	$91.20	$117.49
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $26.30 / $34.67	Professional	26	$22.39	$26.30	$34.67
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $89.13	Professional	TC	$53.70	$69.18	$89.13
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $38.90	Facility	26	$38.90	$38.90	$38.90
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $104.71 / $104.71 / $104.71	Facility	TC	$104.71	$104.71	$104.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $89.13 / $117.49	Professional		$77.62	$89.13	$117.49
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $25.70 / $33.11	Professional	26	$22.39	$25.70	$33.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $89.13	Professional	TC	$53.70	$69.18	$89.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $39.81 / $85.11	Professional		$11.48	$39.81	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $51.29 / $95.50	Professional		$38.90	$51.29	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.80 / $25.70	Professional	26	$10.96	$13.80	$25.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $37.15 / $70.79	Professional	TC	$28.18	$37.15	$70.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $95.50	Professional		$81.28	$81.28	$95.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $18.62 / $22.39	Professional	26	$18.62	$18.62	$22.39
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $61.66 / $72.44	Professional	TC	$61.66	$61.66	$72.44