Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.43 / $58.58 / $87.85	Professional		$47.43	$58.58	$87.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.51 / $25.73 / $102.89	Professional	26	$20.51	$25.73	$102.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.72 / $29.29 / $43.93	Professional	52	$23.72	$29.29	$43.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $33.56 / $49.26	Professional	TC	$26.92	$33.56	$49.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.05 / $121.31 / $170.55	Professional		$49.05	$121.31	$170.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.28 / $50.17 / $70.56	Professional	26	$21.28	$50.17	$70.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.08 / $70.62 / $99.98	Professional	TC	$27.08	$70.62	$99.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $45.88 / $70.84 / $177.90	Professional		$45.88	$70.84	$177.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.73 / $31.72 / $68.77	Professional	26	$19.73	$31.72	$68.77
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.87 / $36.02 / $95.61	Professional	TC	$25.87	$36.02	$95.61
Medica Facility/Professional Facility Modifier Low / Median / High Price $52.52 / $122.77 / $170.55	Facility		$52.52	$122.77	$170.55
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $61.29 / $61.29 / $152.15	Facility	26	$61.29	$61.29	$152.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.01 / $93.02 / $217.06	Professional		$57.01	$93.02	$217.06
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.69 / $32.45 / $73.55	Professional	26	$25.69	$32.45	$73.55
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.92 / $41.91 / $120.09	Professional	TC	$30.92	$41.91	$120.09
Midlands Facility/Professional Facility Modifier Low / Median / High Price $95.14 / $143.65 / $160.65	Facility		$95.14	$143.65	$160.65
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.14 / $132.58 / $167.56	Professional		$95.14	$132.58	$167.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.28 / $57.73 / $111.91	Professional		$26.28	$57.73	$111.91
United Facility/Professional Professional Modifier Low / Median / High Price $56.61 / $74.48 / $137.72	Professional		$56.61	$74.48	$137.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.46 / $31.10 / $61.92	Professional	26	$24.46	$31.10	$61.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.92 / $39.06 / $73.50	Professional	TC	$30.92	$39.06	$73.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $85.30 / $116.50 / $121.10	Professional		$85.30	$116.50	$121.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $35.70 / $48.70 / $50.60	Professional	26	$35.70	$48.70	$50.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $49.70 / $67.80 / $70.50	Professional	TC	$49.70	$67.80	$70.50