Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $113.52 / $113.52 / $247.80	Facility		$113.52	$113.52	$247.80
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $312.07 / $331.36 / $345.98	Facility	TC	$312.07	$331.36	$345.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.64 / $71.58 / $115.09	Professional		$32.64	$71.58	$115.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.77 / $24.51 / $90.70	Professional	26	$17.77	$24.51	$90.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $281.35 / $435.00	Professional	50	$234.74	$281.35	$435.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.37 / $20.68 / $39.33	Professional	52	$15.37	$20.68	$39.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.38 / $22.43 / $63.75	Professional	TC	$13.38	$22.43	$63.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.28 / $95.96 / $197.81	Professional		$53.28	$95.96	$197.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.41 / $51.25 / $82.10	Professional	26	$21.41	$51.25	$82.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.13 / $42.75 / $136.01	Professional	TC	$26.13	$42.75	$136.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $32.82 / $54.98 / $123.03	Professional		$32.82	$54.98	$123.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.91 / $31.14 / $58.56	Professional	26	$18.91	$31.14	$58.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $13.91 / $21.92 / $77.97	Professional	TC	$13.91	$21.92	$77.97
Medica Facility/Professional Facility Modifier Low / Median / High Price $81.16 / $124.22 / $232.02	Facility		$81.16	$124.22	$232.02
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $141.03 / $141.03 / $141.03	Facility	TC	$141.03	$141.03	$141.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $48.96 / $98.33 / $402.37	Professional		$48.96	$98.33	$402.37
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $23.26 / $42.28 / $130.60	Professional	26	$23.26	$42.28	$130.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $54.80 / $284.52	Professional	TC	$23.82	$54.80	$284.52
Midlands Facility/Professional Facility Modifier Low / Median / High Price $76.98 / $90.66 / $134.00	Facility		$76.98	$90.66	$134.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $76.98 / $97.31 / $145.19	Professional		$76.98	$97.31	$145.19
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $127.90 / $601.91 / $1,039.68	Facility		$127.90	$601.91	$1,039.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.77 / $34.28 / $65.98	Professional		$16.77	$34.28	$65.98
United Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $83.53 / $115.79	Professional		$45.83	$83.53	$115.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $31.71 / $57.50	Professional	26	$22.01	$31.71	$57.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.57 / $37.38 / $67.09	Professional	TC	$23.57	$37.38	$67.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $53.56 / $67.80 / $79.80	Professional		$53.56	$67.80	$79.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $29.70 / $37.60 / $44.20	Professional	26	$29.70	$37.60	$44.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $23.86 / $30.20 / $35.50	Professional	TC	$23.86	$30.20	$35.50