Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.28 / $222.60 / $331.36	Facility		$120.28	$222.60	$331.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.82 / $80.39 / $230.90	Professional		$40.82	$80.39	$230.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.75 / $33.15 / $149.00	Professional	26	$25.75	$33.15	$149.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $72.88 / $326.11 / $402.38	Professional	50	$72.88	$326.11	$402.38
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.55 / $25.18 / $42.41	Professional	52	$19.55	$25.18	$42.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.07 / $23.35 / $71.00	Professional	TC	$15.07	$23.35	$71.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.98 / $123.00 / $217.85	Professional		$72.98	$123.00	$217.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.12 / $72.73 / $101.36	Professional	26	$31.12	$72.73	$101.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.28 / $45.36 / $104.44	Professional	TC	$35.28	$45.36	$104.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $42.17 / $70.53 / $179.79	Professional		$42.17	$70.53	$179.79
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.41 / $42.76 / $102.74	Professional	26	$27.41	$42.76	$102.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.76 / $22.79 / $92.32	Professional	TC	$14.76	$22.79	$92.32
Medica Facility/Professional Facility Modifier Low / Median / High Price $66.75 / $141.96 / $267.77	Facility		$66.75	$141.96	$267.77
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $134.74 / $134.74 / $134.74	Facility	26	$134.74	$134.74	$134.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $64.98 / $124.13 / $459.15	Professional		$64.98	$124.13	$459.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $50.53 / $188.73	Professional	26	$31.76	$50.53	$188.73
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $31.49 / $67.11 / $313.58	Professional	TC	$31.49	$67.11	$313.58
Midlands Facility/Professional Facility Modifier Low / Median / High Price $105.21 / $124.13 / $152.00	Facility		$105.21	$124.13	$152.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.13 / $131.54 / $175.41	Professional		$93.13	$131.54	$175.41
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $138.94 / $138.94 / $138.94	Facility		$138.94	$138.94	$138.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.80 / $61.80 / $241.50	Professional		$61.80	$61.80	$241.50
United Facility/Professional Professional Modifier Low / Median / High Price $63.52 / $111.25 / $214.42	Professional		$63.52	$111.25	$214.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $42.14 / $82.58	Professional	26	$31.76	$42.14	$82.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.49 / $55.31 / $79.67	Professional	TC	$31.49	$55.31	$79.67
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $68.65 / $86.90 / $102.20	Professional		$68.65	$86.90	$102.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $43.29 / $54.80 / $64.50	Professional	26	$43.29	$54.80	$64.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $25.28 / $32.00 / $37.70	Professional	TC	$25.28	$32.00	$37.70