Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.39 / $52.97 / $65.34	Facility	26	$34.39	$52.97	$65.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.77 / $130.40 / $553.00	Professional		$37.77	$130.40	$553.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.40 / $41.38 / $115.28	Professional	26	$34.40	$41.38	$115.28
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $95.26 / $95.26 / $95.26	Professional	52	$95.26	$95.26	$95.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.98 / $89.15 / $246.36	Professional	TC	$74.98	$89.15	$246.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.28 / $128.01 / $131.74	Facility	26	$124.28	$128.01	$131.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.57 / $294.77 / $368.46	Professional		$138.57	$294.77	$368.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.36 / $86.88 / $108.60	Professional	26	$38.36	$86.88	$108.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.40 / $207.89 / $259.86	Professional	TC	$95.40	$207.89	$259.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $124.00 / $164.76 / $574.36	Professional		$124.00	$164.76	$574.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.45 / $126.11	Professional	26	$38.90	$51.45	$126.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.12 / $113.97 / $404.64	Professional	TC	$85.12	$113.97	$404.64
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $128.01 / $172.60 / $172.60	Facility	26	$128.01	$172.60	$172.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $137.94 / $205.65 / $571.98	Professional		$137.94	$205.65	$571.98
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.61 / $51.93 / $242.65	Professional	26	$40.61	$51.93	$242.65
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $89.83 / $113.47 / $567.92	Professional	TC	$89.83	$113.47	$567.92
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $128.01 / $131.74 / $213.78	Facility	26	$128.01	$131.74	$213.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $228.68 / $268.29 / $426.83	Professional		$228.68	$268.29	$426.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $38.59 / $112.73 / $206.67	Professional		$38.59	$112.73	$206.67
United Facility/Professional Professional Modifier Low / Median / High Price $127.92 / $163.30 / $265.66	Professional		$127.92	$163.30	$265.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.85 / $51.86 / $92.07	Professional	26	$39.85	$51.86	$92.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.83 / $111.44 / $183.48	Professional	TC	$89.83	$111.44	$183.48
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $183.52 / $232.30 / $273.30	Professional		$183.52	$232.30	$273.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $55.54 / $70.30 / $82.60	Professional	26	$55.54	$70.30	$82.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $128.06 / $162.10 / $190.70	Professional	TC	$128.06	$162.10	$190.70