Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.74 / $46.74 / $83.47	Facility	26	$46.74	$46.74	$83.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.69 / $75.34 / $378.75	Professional		$49.69	$75.34	$378.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $26.98 / $137.99	Professional	26	$23.46	$26.98	$137.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.85 / $27.26 / $351.00	Professional	52	$24.85	$27.26	$351.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.09 / $33.32 / $69.59	Professional	TC	$25.09	$33.32	$69.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.83 / $84.28 / $86.74	Facility	26	$81.83	$84.28	$86.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.50 / $134.19 / $224.97	Professional		$83.50	$134.19	$224.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $61.28 / $85.23	Professional	26	$29.75	$61.28	$85.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.34 / $72.92 / $158.05	Professional	TC	$53.34	$72.92	$158.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.46 / $95.50 / $304.73	Professional		$52.46	$95.50	$304.73
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.36 / $40.85 / $107.87	Professional	26	$25.36	$40.85	$107.87
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.39 / $49.94 / $186.50	Professional	TC	$26.39	$49.94	$186.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $84.28 / $122.62 / $122.62	Facility	26	$84.28	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.98 / $114.93 / $447.95	Professional		$77.98	$114.93	$447.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.74 / $36.85 / $265.83	Professional	26	$27.74	$36.85	$265.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $48.27 / $61.27 / $398.99	Professional	TC	$48.27	$61.27	$398.99
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $84.28 / $86.74 / $150.12	Facility	26	$84.28	$86.74	$150.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.43 / $146.93 / $198.38	Professional		$107.43	$146.93	$198.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.46 / $50.91 / $104.53	Professional		$27.46	$50.91	$104.53
United Facility/Professional Professional Modifier Low / Median / High Price $74.28 / $96.43 / $221.74	Professional		$74.28	$96.43	$221.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.74 / $33.96 / $58.71	Professional	26	$27.74	$33.96	$58.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.94 / $59.88 / $115.79	Professional	TC	$46.94	$59.88	$115.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $81.53 / $103.20 / $121.40	Professional		$81.53	$103.20	$121.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $37.92 / $48.00 / $56.50	Professional	26	$37.92	$48.00	$56.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $43.53 / $55.10 / $64.90	Professional	TC	$43.53	$55.10	$64.90