Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.76 / $56.54 / $106.33	Facility	26	$29.76	$56.54	$106.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.75 / $178.83 / $450.00	Professional		$104.75	$178.83	$450.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $49.74 / $156.00	Professional	26	$29.75	$49.74	$156.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.11 / $57.02 / $249.00	Professional	52	$50.11	$57.02	$249.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.98 / $94.62 / $239.41	Professional	TC	$74.98	$94.62	$239.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.72 / $104.77 / $107.82	Facility	26	$101.72	$104.77	$107.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.84 / $276.92 / $346.16	Professional		$108.84	$276.92	$346.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.72 / $75.23 / $100.85	Professional	26	$37.72	$75.23	$100.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $201.68 / $252.10	Professional	TC	$76.23	$201.68	$252.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $160.29 / $307.58	Professional		$102.94	$160.29	$307.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.58 / $49.56 / $126.40	Professional	26	$30.58	$49.56	$126.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.36 / $113.30 / $206.99	Professional	TC	$72.36	$113.30	$206.99
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $104.77 / $148.36 / $148.36	Facility	26	$104.77	$148.36	$148.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $115.20 / $188.93 / $778.42	Professional		$115.20	$188.93	$778.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.86 / $44.11 / $290.60	Professional	26	$33.86	$44.11	$290.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $77.26 / $105.90 / $570.15	Professional	TC	$77.26	$105.90	$570.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $104.77 / $107.82 / $182.40	Facility	26	$104.77	$107.82	$182.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $150.10 / $246.50 / $329.67	Professional		$150.10	$246.50	$329.67
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.04 / $108.44 / $193.57	Professional		$33.04	$108.44	$193.57
United Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $149.75 / $280.02	Professional		$109.44	$149.75	$280.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.67 / $43.02 / $74.76	Professional	26	$32.67	$43.02	$74.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.26 / $99.09 / $188.13	Professional	TC	$77.26	$99.09	$188.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $165.35 / $209.30 / $246.20	Professional		$165.35	$209.30	$246.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $45.90 / $58.10 / $68.40	Professional	26	$45.90	$58.10	$68.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $119.45 / $151.19 / $177.90	Professional	TC	$119.45	$151.19	$177.90