Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $48.98 / $58.88	Facility	26	$23.99	$48.98	$58.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $91.20 / $446.68	Professional		$48.98	$91.20	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $41.69 / $151.36	Professional	26	$23.44	$41.69	$151.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $57.54 / $100.00 / $371.54	Professional	52	$57.54	$100.00	$371.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $47.86 / $194.98	Professional	TC	$25.12	$47.86	$194.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $85.11 / $87.10	Facility	26	$81.28	$85.11	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $138.04 / $181.97	Professional		$83.18	$138.04	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $63.10 / $77.62	Professional	26	$29.51	$63.10	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $74.13 / $102.33	Professional	TC	$53.70	$74.13	$102.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $151.36 / $309.03	Professional		$57.54	$151.36	$309.03
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $48.98 / $120.23	Professional	26	$27.54	$48.98	$120.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $83.18 / $186.21	Professional	TC	$28.18	$83.18	$186.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $123.03 / $123.03	Facility	26	$85.11	$123.03	$123.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $446.68	Professional		$74.13	$117.49	$446.68
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $36.31 / $263.03	Professional	26	$26.92	$36.31	$263.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $398.11	Professional	TC	$46.77	$61.66	$398.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $147.91 / $199.53	Professional		$112.20	$147.91	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $63.10 / $93.33	Professional	26	$52.48	$63.10	$93.33
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $77.62 / $134.90	Professional	TC	$58.88	$77.62	$134.90
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $87.10 / $87.10	Facility	26	$87.10	$87.10	$87.10
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $177.83 / $177.83	Professional		$134.90	$177.83	$177.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $85.11	Professional	26	$52.48	$69.18	$85.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $104.71 / $125.89	Professional	TC	$72.44	$104.71	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $54.95 / $104.71	Professional		$28.84	$54.95	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $89.13 / $177.83	Professional		$72.44	$89.13	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $33.88 / $61.66	Professional	26	$26.92	$33.88	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $58.88 / $117.49	Professional	TC	$45.71	$58.88	$117.49
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $102.33 / $120.23	Professional		$102.33	$102.33	$120.23
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $47.86 / $56.23	Professional	26	$47.86	$47.86	$56.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $64.57	Professional	TC	$54.95	$54.95	$64.57