Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.97 / $94.33 / $175.18	Facility	26	$39.97	$94.33	$175.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.31 / $70.01 / $117.34	Professional		$57.31	$70.01	$117.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.75 / $28.63 / $51.82	Professional	26	$25.75	$28.63	$51.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.30 / $31.75 / $42.50	Professional	52	$27.30	$31.75	$42.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.56 / $39.59 / $54.49	Professional	TC	$31.56	$39.59	$54.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.35 / $96.15 / $98.95	Facility	26	$93.35	$96.15	$98.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.05 / $159.79 / $205.04	Professional		$87.05	$159.79	$205.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.12 / $69.81 / $94.94	Professional	26	$31.12	$69.81	$94.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.47 / $89.98 / $128.15	Professional	TC	$53.47	$89.98	$128.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $61.47 / $101.81 / $229.96	Professional		$61.47	$101.81	$229.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.95 / $43.24 / $110.13	Professional	26	$27.95	$43.24	$110.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.35 / $55.74 / $135.44	Professional	TC	$32.35	$55.74	$135.44
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $96.15 / $136.22 / $136.22	Facility	26	$96.15	$136.22	$136.22
Medica Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $120.62 / $497.00	Professional		$67.84	$120.62	$497.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.92 / $39.64 / $320.31	Professional	26	$28.92	$39.64	$320.31
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $35.82 / $49.65 / $320.31	Professional	TC	$35.82	$49.65	$320.31
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $96.15 / $98.95 / $167.94	Facility	26	$96.15	$98.95	$167.94
Midlands Facility/Professional Professional Modifier Low / Median / High Price $128.38 / $149.29 / $198.92	Professional		$128.38	$149.29	$198.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $90.40 / $90.40 / $225.80	Professional		$90.40	$90.40	$225.80
United Facility/Professional Professional Modifier Low / Median / High Price $66.15 / $82.04 / $153.13	Professional		$66.15	$82.04	$153.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.25 / $36.53 / $67.61	Professional	26	$28.25	$36.53	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.54 / $42.43 / $79.20	Professional	TC	$34.54	$42.43	$79.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $95.51 / $120.90 / $142.30	Professional		$95.51	$120.90	$142.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.19 / $53.40 / $62.80	Professional	26	$42.19	$53.40	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.40 / $67.59 / $79.50	Professional	TC	$53.40	$67.59	$79.50