Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $144.54	Professional		$47.86	$67.61	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.92 / $107.15	Professional	26	$19.95	$26.92	$107.15
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	52	$42.66	$42.66	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.11 / $63.10	Professional	TC	$25.70	$33.11	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $100.00 / $165.96	Professional		$46.77	$100.00	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $43.65 / $69.18	Professional	26	$19.95	$43.65	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $58.88 / $95.50	Professional	TC	$26.30	$58.88	$95.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $63.10 / $165.96	Professional		$45.71	$63.10	$165.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $30.90 / $69.18	Professional	26	$19.50	$30.90	$69.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $95.50	Professional	TC	$25.70	$36.31	$95.50
Medica Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $107.15 / $169.82	Facility		$52.48	$107.15	$169.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Facility	26	$61.66	$61.66	$61.66
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $91.20 / $218.78	Professional		$57.54	$91.20	$218.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $33.88 / $75.86	Professional	26	$25.12	$33.88	$75.86
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $141.25	Professional	TC	$32.36	$45.71	$141.25
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $95.50	Professional	26	$45.71	$66.07	$95.50
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $91.20 / $162.18	Professional	TC	$83.18	$91.20	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $60.26 / $125.89	Professional		$27.54	$60.26	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $70.79 / $125.89	Professional		$56.23	$70.79	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $31.62 / $56.23	Professional	26	$24.55	$31.62	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $38.90 / $74.13	Professional	TC	$30.90	$38.90	$74.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $117.49 / $128.82	Professional		$85.11	$117.49	$128.82
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $53.70	Professional	26	$35.48	$48.98	$53.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $67.61 / $74.13	Professional	TC	$50.12	$67.61	$74.13