Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.25 / $118.46 / $118.46	Facility	26	$41.25	$118.46	$118.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.03 / $196.46 / $694.00	Professional		$86.03	$196.46	$694.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.13 / $62.35 / $244.17	Professional	26	$41.13	$62.35	$244.17
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $199.10 / $284.36 / $392.92	Professional	50	$199.10	$284.36	$392.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.17 / $52.38 / $122.56	Professional	TC	$40.17	$52.38	$122.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.77 / $202.28 / $264.97	Professional		$149.77	$202.28	$264.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.52 / $99.78 / $128.62	Professional	26	$70.52	$99.78	$128.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.00 / $105.38 / $139.31	Professional	TC	$74.00	$105.38	$139.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $82.89 / $121.12 / $304.82	Professional		$82.89	$121.12	$304.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.19 / $63.21 / $155.13	Professional	26	$41.19	$63.21	$155.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.70 / $63.23 / $96.58	Professional	TC	$41.70	$63.23	$96.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $122.09 / $206.98 / $641.76	Professional		$122.09	$206.98	$641.76
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $59.10 / $103.60 / $283.72	Professional	26	$59.10	$103.60	$283.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $53.46 / $99.94 / $358.05	Professional	TC	$53.46	$99.94	$358.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $135.27 / $191.10 / $264.97	Professional		$135.27	$191.10	$264.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $44.44 / $84.52 / $167.95	Professional		$44.44	$84.52	$167.95
United Facility/Professional Professional Modifier Low / Median / High Price $103.09 / $177.17 / $251.27	Professional		$103.09	$177.17	$251.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.03 / $79.05 / $123.05	Professional	26	$52.03	$79.05	$123.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.19 / $92.03 / $128.22	Professional	TC	$54.19	$92.03	$128.22
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $147.57 / $186.80 / $219.80	Professional		$147.57	$186.80	$219.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.06 / $88.70 / $104.40	Professional	26	$70.06	$88.70	$104.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $77.50 / $98.10 / $115.40	Professional	TC	$77.50	$98.10	$115.40