Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.21 / $59.48 / $111.82	Facility	26	$48.21	$59.48	$111.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.97 / $104.51 / $463.00	Professional		$87.97	$104.51	$463.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.06 / $33.68 / $71.92	Professional	26	$30.06	$33.68	$71.92
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $122.27 / $694.50 / $840.00	Professional	50	$122.27	$694.50	$840.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.22 / $66.03 / $105.22	Professional	TC	$59.22	$66.03	$105.22
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.95 / $118.40 / $121.85	Facility	26	$114.95	$118.40	$121.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.22 / $238.92 / $298.64	Professional		$114.22	$238.92	$298.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.71 / $79.12 / $98.90	Professional	26	$40.71	$79.12	$98.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.63 / $159.79 / $199.74	Professional	TC	$73.63	$159.79	$199.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $100.86 / $153.74 / $315.20	Professional		$100.86	$153.74	$315.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.40 / $50.04 / $112.91	Professional	26	$35.40	$50.04	$112.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.45 / $89.61 / $162.71	Professional	TC	$65.45	$89.61	$162.71
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $118.40 / $157.44 / $157.44	Facility	26	$118.40	$157.44	$157.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $103.43 / $150.91 / $651.61	Professional		$103.43	$150.91	$651.61
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.78 / $46.41 / $219.03	Professional	26	$35.78	$46.41	$219.03
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $191.87 / $191.87 / $191.87	Professional	50	$191.87	$191.87	$191.87
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $64.97 / $84.60 / $448.58	Professional	TC	$64.97	$84.60	$448.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $118.40 / $121.85 / $192.66	Facility	26	$118.40	$121.85	$192.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $192.53 / $217.76 / $346.43	Professional		$192.53	$217.76	$346.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.94 / $91.69 / $168.15	Professional		$34.94	$91.69	$168.15
United Facility/Professional Professional Modifier Low / Median / High Price $102.99 / $121.76 / $231.20	Professional		$102.99	$121.76	$231.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.92 / $44.61 / $81.90	Professional	26	$35.92	$44.61	$81.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.06 / $84.58 / $149.30	Professional	TC	$66.06	$84.58	$149.30
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $143.31 / $181.40 / $213.40	Professional		$143.31	$181.40	$213.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $48.74 / $61.70 / $72.50	Professional	26	$48.74	$61.70	$72.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $94.64 / $119.80 / $140.90	Professional	TC	$94.64	$119.80	$140.90