Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.28 / $30.93 / $49.98	Facility	26	$16.28	$30.93	$49.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.54 / $111.47 / $410.00	Professional		$75.54	$111.47	$410.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.91 / $12.99 / $65.04	Professional	26	$10.91	$12.99	$65.04
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.77 / $47.70 / $92.48	Professional	52	$37.77	$47.70	$92.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.54 / $93.44 / $131.53	Professional	TC	$64.54	$93.44	$131.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.82 / $196.71 / $336.23	Professional		$89.82	$196.71	$336.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.69 / $28.79 / $44.90	Professional	26	$12.69	$28.79	$44.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.52 / $168.11 / $291.31	Professional	TC	$77.52	$168.11	$291.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $72.31 / $113.46 / $207.43	Professional		$72.31	$113.46	$207.43
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $18.63 / $54.45	Professional	26	$10.96	$18.63	$54.45
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.60 / $90.26 / $185.36	Professional	TC	$59.60	$90.26	$185.36
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $125.86 / $125.86 / $125.86	Facility	26	$125.86	$125.86	$125.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $100.74 / $180.22 / $768.54	Professional		$100.74	$180.22	$768.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.62 / $25.01 / $267.48	Professional	26	$13.62	$25.01	$267.48
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $76.59 / $152.38 / $698.48	Professional	TC	$76.59	$152.38	$698.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $108.00 / $184.42 / $233.86	Professional		$108.00	$184.42	$233.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.49 / $74.81 / $143.59	Professional		$12.49	$74.81	$143.59
United Facility/Professional Professional Modifier Low / Median / High Price $86.62 / $159.57 / $214.06	Professional		$86.62	$159.57	$214.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.99 / $19.36 / $32.90	Professional	26	$12.99	$19.36	$32.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.63 / $124.26 / $181.15	Professional	TC	$73.63	$124.26	$181.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $119.29 / $151.00 / $177.60	Professional		$119.29	$151.00	$177.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.05 / $21.60 / $25.40	Professional	26	$17.05	$21.60	$25.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $102.23 / $129.40 / $152.30	Professional	TC	$102.23	$129.40	$152.30