Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.20 / $170.95 / $362.60	Facility		$93.20	$170.95	$362.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.62 / $23.54 / $43.42	Facility	26	$6.62	$23.54	$43.42
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $31.20 / $70.72 / $275.75	Facility	TC	$31.20	$70.72	$275.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.30 / $33.46 / $155.49	Professional		$24.30	$33.46	$155.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.62 / $7.83 / $40.79	Professional	26	$6.62	$7.83	$40.79
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $65.00 / $65.00 / $66.92	Professional	50	$65.00	$65.00	$66.92
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.12 / $13.71 / $109.17	Professional	52	$12.12	$13.71	$109.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $21.07 / $70.40	Professional	TC	$17.89	$21.07	$70.40
Cigna Facility/Professional Facility Modifier Low / Median / High Price $84.50 / $87.04 / $89.57	Facility		$84.50	$87.04	$89.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.50 / $23.18 / $23.85	Facility	26	$22.50	$23.18	$23.85
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $62.00 / $63.86 / $65.72	Facility	TC	$62.00	$63.86	$65.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.68 / $65.93 / $82.42	Professional		$28.68	$65.93	$82.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $16.29 / $22.28	Professional	26	$7.88	$16.29	$22.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.80 / $49.64 / $62.06	Professional	TC	$20.80	$49.64	$62.06
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $24.77 / $40.50 / $69.44	Professional		$24.77	$40.50	$69.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.89 / $11.22 / $25.13	Professional	26	$6.89	$11.22	$25.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.88 / $27.52 / $35.81	Professional	TC	$17.88	$27.52	$35.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $37.79 / $58.95 / $239.94	Facility		$37.79	$58.95	$239.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $23.18 / $100.00 / $100.00	Facility	26	$23.18	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $63.86 / $100.00 / $100.00	Facility	TC	$63.86	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $25.72 / $44.50 / $180.63	Professional		$25.72	$44.50	$180.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $7.82 / $9.84 / $67.70	Professional	26	$7.82	$9.84	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $24.17 / $154.00	Professional	TC	$18.16	$24.17	$154.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $60.48 / $96.22	Facility		$50.00	$60.48	$96.22
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $23.18 / $23.85 / $41.04	Facility	26	$23.18	$23.85	$41.04
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $63.86 / $65.72 / $114.12	Facility	TC	$63.86	$65.72	$114.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $45.69 / $56.29 / $93.64	Professional		$45.69	$56.29	$93.64
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $84.06 / $1,414.56 / $2,879.66	Facility		$84.06	$1,414.56	$2,879.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $7.52 / $21.86 / $48.41	Professional		$7.52	$21.86	$48.41
United Facility/Professional Professional Modifier Low / Median / High Price $25.72 / $33.49 / $55.17	Professional		$25.72	$33.49	$55.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.56 / $9.07 / $15.86	Professional	26	$7.56	$9.07	$15.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $23.65 / $38.95	Professional	TC	$18.16	$23.65	$38.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $38.32 / $48.50 / $57.10	Professional		$38.32	$48.50	$57.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $12.60 / $14.80	Professional	26	$9.94	$12.60	$14.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $28.44 / $36.00 / $42.30	Professional	TC	$28.44	$36.00	$42.30