Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $194.98 / $389.05	Facility		$54.95	$194.98	$389.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $14.13 / $16.60	Facility	26	$7.08	$14.13	$16.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $23.99 / $104.71 / $549.54	Facility	TC	$23.99	$104.71	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $7.94 / $38.02 / $158.49	Professional		$7.94	$38.02	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.49 / $46.77	Professional	26	$7.08	$13.49	$46.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $85.11 / $218.78	Professional	50	$17.78	$85.11	$218.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.71 / $251.19 / $251.19	Professional	52	$45.71	$251.19	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $35.48 / $123.03	Professional	TC	$20.89	$35.48	$123.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $100.00 / $102.33	Facility		$97.72	$100.00	$102.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $30.20 / $30.90	Facility	26	$29.51	$30.20	$30.90
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $67.61 / $69.18 / $70.79	Facility	TC	$67.61	$69.18	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $81.28 / $102.33	Professional		$39.81	$81.28	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $18.20 / $23.99	Professional	26	$10.47	$18.20	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $63.10 / $77.62	Professional	TC	$27.54	$63.10	$77.62
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $46.77 / $109.65	Professional		$30.20	$46.77	$109.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $12.88 / $40.74	Professional	26	$7.41	$12.88	$40.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $61.66	Professional	TC	$22.91	$33.88	$61.66
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $87.10 / $346.74	Facility		$45.71	$87.10	$346.74
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $100.00 / $100.00	Facility	26	$30.20	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $69.18 / $117.49 / $117.49	Facility	TC	$69.18	$117.49	$117.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $53.70 / $218.78	Professional		$30.20	$53.70	$218.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $13.18 / $67.61	Professional	26	$8.71	$13.18	$67.61
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $33.11 / $169.82	Professional	TC	$21.38	$33.11	$169.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $72.44 / $112.20	Professional		$58.88	$72.44	$112.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $19.50 / $26.92	Professional	26	$16.22	$19.50	$26.92
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $54.95 / $85.11	Professional	TC	$40.74	$54.95	$85.11
Midlands Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $102.33 / $102.33	Facility		$102.33	$102.33	$102.33
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	26	$30.90	$30.90	$30.90
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $70.79 / $70.79 / $70.79	Facility	TC	$70.79	$70.79	$70.79
Midlands Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $63.10 / $87.10	Professional		$60.26	$63.10	$87.10
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $18.62 / $23.99	Professional	26	$17.38	$18.62	$23.99
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $44.67 / $66.07	Professional	TC	$42.66	$44.67	$66.07
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.32 / $27.54 / $58.88	Professional		$8.32	$27.54	$58.88
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $199.53 / $269.15	Facility		$114.82	$199.53	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.02 / $72.44	Professional		$29.51	$38.02	$72.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.23 / $19.05	Professional	26	$8.13	$10.23	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $28.18 / $50.12	Professional	TC	$21.38	$28.18	$50.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $69.18	Professional		$57.54	$57.54	$69.18
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $13.80 / $16.22	Professional	26	$13.80	$13.80	$16.22
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $52.48	Professional	TC	$44.67	$44.67	$52.48