Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.78 / $155.31 / $811.30	Facility		$42.78	$155.31	$811.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.19 / $161.31 / $299.77	Facility	26	$69.19	$161.31	$299.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.30 / $81.06 / $178.02	Professional		$42.30	$81.06	$178.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.42 / $31.40 / $124.74	Professional	26	$26.42	$31.40	$124.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $94.51 / $94.51 / $652.41	Professional	50	$94.51	$94.51	$652.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.00 / $18.57 / $45.23	Professional	TC	$15.00	$18.57	$45.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $283.32 / $291.82 / $300.32	Facility		$283.32	$291.82	$300.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $160.91 / $165.75 / $170.58	Facility	26	$160.91	$165.75	$170.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.40 / $121.30 / $233.51	Professional		$77.40	$121.30	$233.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.54 / $69.81 / $131.00	Professional	26	$39.54	$69.81	$131.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.31 / $44.44 / $101.09	Professional	TC	$32.31	$44.44	$101.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $43.51 / $112.58 / $279.82	Professional		$43.51	$112.58	$279.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $44.72 / $155.99	Professional	26	$28.01	$44.72	$155.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.05 / $28.06 / $133.16	Professional	TC	$15.05	$28.06	$133.16
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.20 / $155.31 / $323.83	Facility		$45.20	$155.31	$323.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $165.75 / $198.78 / $198.78	Facility	26	$165.75	$198.78	$198.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $55.33 / $101.77 / $659.45	Professional		$55.33	$101.77	$659.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.72 / $50.76 / $335.18	Professional	26	$33.72	$50.76	$335.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.41 / $37.56 / $404.98	Professional	TC	$21.41	$37.56	$404.98
Midlands Facility/Professional Facility Modifier Low / Median / High Price $95.47 / $138.53 / $291.82	Facility		$95.47	$138.53	$291.82
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $165.75 / $170.58 / $170.58	Facility	26	$165.75	$170.58	$170.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $92.49 / $130.24 / $206.14	Professional		$92.49	$130.24	$206.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $62.60 / $62.60 / $253.00	Professional		$62.60	$62.60	$253.00
United Facility/Professional Facility Modifier Low / Median / High Price $147.11 / $151.31 / $217.94	Facility		$147.11	$151.31	$217.94
United Facility/Professional Professional Modifier Low / Median / High Price $53.77 / $82.49 / $245.05	Professional		$53.77	$82.49	$245.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $43.84 / $74.94	Professional	26	$32.11	$43.84	$74.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.57 / $31.71 / $58.99	Professional	TC	$20.57	$31.71	$58.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $66.98 / $84.80 / $99.70	Professional		$66.98	$84.80	$99.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.19 / $53.40 / $62.80	Professional	26	$42.19	$53.40	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $24.81 / $31.40 / $37.00	Professional	TC	$24.81	$31.40	$37.00