Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $169.82 / $537.03	Facility		$38.02	$169.82	$537.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $10.23 / $21.88	Facility	26	$8.91	$10.23	$21.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.30 / $100.00 / $537.03	Facility	TC	$26.30	$100.00	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $57.54 / $190.55	Professional		$33.11	$57.54	$190.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $15.85 / $52.48	Professional	26	$8.91	$15.85	$52.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $26.92 / $120.23 / $186.21	Professional	50	$26.92	$120.23	$186.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.98 / $147.91 / $162.18	Professional	52	$16.98	$147.91	$162.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $33.88 / $117.49	Professional	TC	$23.99	$33.88	$117.49
Cigna Facility/Professional Facility Modifier Low / Median / High Price $154.88 / $158.49 / $162.18	Facility		$154.88	$158.49	$162.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $47.86 / $48.98	Facility	26	$45.71	$47.86	$48.98
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $109.65 / $112.20 / $114.82	Facility	TC	$109.65	$112.20	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $97.72 / $123.03	Professional		$46.77	$97.72	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $24.55 / $30.90	Professional	26	$13.49	$24.55	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $74.13 / $93.33	Professional	TC	$32.36	$74.13	$93.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $67.61 / $169.82	Professional		$40.74	$67.61	$169.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.22 / $47.86	Professional	26	$10.96	$16.22	$47.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.90 / $117.49	Professional	TC	$27.54	$38.90	$117.49
Medica Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $95.50 / $346.74	Facility		$46.77	$95.50	$346.74
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $70.79 / $70.79	Facility	26	$47.86	$70.79	$70.79
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $112.20 / $138.04 / $263.03	Facility	TC	$112.20	$138.04	$263.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $67.61 / $263.03	Professional		$38.02	$67.61	$263.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $14.79 / $67.61	Professional	26	$11.22	$14.79	$67.61
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $34.67 / $194.98	Professional	TC	$26.30	$34.67	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $89.13 / $102.33	Professional		$72.44	$89.13	$102.33
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $24.55 / $31.62	Professional	26	$21.38	$24.55	$31.62
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $66.07 / $77.62	Professional	TC	$50.12	$66.07	$77.62
Midlands Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Facility		$162.18	$162.18	$162.18
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $48.98 / $48.98	Facility	26	$48.98	$48.98	$48.98
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	TC	$114.82	$114.82	$114.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $97.72 / $102.33	Professional		$77.62	$97.72	$102.33
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $25.12 / $31.62	Professional	26	$23.99	$25.12	$31.62
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $72.44 / $77.62	Professional	TC	$53.70	$72.44	$77.62
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Facility		$109.65	$109.65	$109.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $32.36 / $70.79	Professional		$10.96	$32.36	$70.79
United Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $239.88 / $323.59	Facility		$151.36	$239.88	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $46.77 / $87.10	Professional		$37.15	$46.77	$87.10
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 $26.30 / $32.36 / $61.66	Professional	TC	$26.30	$32.36	$61.66
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $83.18	Professional		$70.79	$70.79	$83.18
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.20 / $21.38	Professional	26	$18.20	$18.20	$21.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $61.66	Professional	TC	$52.48	$52.48	$61.66