Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $46.15 / $125.95 / $324.80	Facility		$46.15	$125.95	$324.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.09 / $13.66 / $41.02	Facility	26	$7.09	$13.66	$41.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.50 / $51.84 / $92.79	Facility	TC	$29.50	$51.84	$92.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.90 / $31.31 / $147.00	Professional		$14.90	$31.31	$147.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $8.19 / $39.79	Professional	26	$7.00	$8.19	$39.79
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $47.97 / $47.97 / $76.09	Professional	50	$47.97	$47.97	$76.09
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.01 / $14.61 / $30.60	Professional	52	$13.01	$14.61	$30.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.53 / $22.68 / $56.78	Professional	TC	$18.53	$22.68	$56.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.88 / $92.58 / $95.27	Facility		$89.88	$92.58	$95.27
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.99 / $25.74 / $26.49	Facility	26	$24.99	$25.74	$26.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $64.89 / $66.84 / $68.78	Facility	TC	$64.89	$66.84	$68.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.63 / $74.30 / $93.08	Professional		$31.63	$74.30	$93.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.21 / $17.07 / $22.36	Professional	26	$8.21	$17.07	$22.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.06 / $56.50 / $71.75	Professional	TC	$22.06	$56.50	$71.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $27.89 / $42.88 / $72.08	Professional		$27.89	$42.88	$72.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.17 / $11.72 / $25.00	Professional	26	$7.17	$11.72	$25.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $20.72 / $31.15 / $40.86	Professional	TC	$20.72	$31.15	$40.86
Medica Facility/Professional Facility Modifier Low / Median / High Price $38.93 / $62.77 / $239.94	Facility		$38.93	$62.77	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $25.74 / $100.00 / $100.00	Facility	26	$25.74	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $66.84 / $110.49 / $110.49	Facility	TC	$66.84	$110.49	$110.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.32 / $47.79 / $206.66	Professional		$29.32	$47.79	$206.66
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.70 / $67.70	Professional	26	$8.22	$10.70	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.76 / $28.03 / $157.81	Professional	TC	$20.76	$28.03	$157.81
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $68.31 / $108.68	Facility		$50.00	$68.31	$108.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $25.74 / $26.49 / $42.84	Facility	26	$25.74	$26.49	$42.84
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $66.84 / $68.78 / $132.12	Facility	TC	$66.84	$68.78	$132.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $46.00 / $62.77 / $93.64	Professional		$46.00	$62.77	$93.64
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $139.03 / $139.03 / $139.03	Facility		$139.03	$139.03	$139.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $7.85 / $25.29 / $54.41	Professional		$7.85	$25.29	$54.41
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 $29.32 / $38.18 / $60.78	Professional		$29.32	$38.18	$60.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.22 / $10.28 / $17.23	Professional	26	$8.22	$10.28	$17.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.10 / $27.48 / $52.75	Professional	TC	$21.10	$27.48	$52.75
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $43.29 / $54.80 / $64.50	Professional		$43.29	$54.80	$64.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $10.35 / $13.10 / $15.40	Professional	26	$10.35	$13.10	$15.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $32.94 / $41.70 / $49.00	Professional	TC	$32.94	$41.70	$49.00