Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $217.00 / $244.30 / $254.77	Facility		$217.00	$244.30	$254.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.88 / $30.44 / $52.45	Professional		$18.88	$30.44	$52.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.57 / $3.91 / $5.51	Professional	26	$2.57	$3.91	$5.51
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.31 / $11.46 / $15.84	Professional	52	$9.31	$11.46	$15.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.30 / $25.10 / $31.49	Professional	TC	$16.30	$25.10	$31.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.51 / $53.90 / $97.35	Professional		$22.51	$53.90	$97.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.27 / $6.98 / $13.05	Professional	26	$3.27	$6.98	$13.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.23 / $44.93 / $85.90	Professional	TC	$19.23	$44.93	$85.90
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $19.80 / $30.49 / $87.47	Professional		$19.80	$30.49	$87.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $2.76 / $4.37 / $18.82	Professional	26	$2.76	$4.37	$18.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.03 / $26.23 / $52.20	Professional	TC	$17.03	$26.23	$52.20
Medica Facility/Professional Facility Modifier Low / Median / High Price $42.75 / $56.59 / $117.97	Facility		$42.75	$56.59	$117.97
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $24.13 / $52.37 / $311.26	Professional		$24.13	$52.37	$311.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $3.25 / $6.93 / $129.00	Professional	26	$3.25	$6.93	$129.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.75 / $36.96 / $252.63	Professional	TC	$19.75	$36.96	$252.63
Midlands Facility/Professional Facility Modifier Low / Median / High Price $40.01 / $48.99 / $78.00	Facility		$40.01	$48.99	$78.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $32.09 / $48.99 / $78.00	Professional		$32.09	$48.99	$78.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $31.10 / $31.10 / $69.00	Professional		$31.10	$31.10	$69.00
United Facility/Professional Professional Modifier Low / Median / High Price $22.38 / $40.71 / $113.77	Professional		$22.38	$40.71	$113.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $3.23 / $4.59 / $10.74	Professional	26	$3.23	$4.59	$10.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $28.50 / $46.70	Professional	TC	$19.13	$28.50	$46.70
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $33.58 / $42.50 / $50.00	Professional		$33.58	$42.50	$50.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $4.34 / $5.50 / $6.50	Professional	26	$4.34	$5.50	$6.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $29.23 / $37.00 / $43.50	Professional	TC	$29.23	$37.00	$43.50