Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.69 / $31.48 / $31.48	Facility	26	$15.69	$31.48	$31.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.23 / $67.84 / $261.00	Professional		$50.23	$67.84	$261.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.12 / $16.57 / $61.80	Professional	26	$11.12	$16.57	$61.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $20.88 / $28.49 / $144.32	Professional	52	$20.88	$28.49	$144.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.86 / $46.03 / $107.02	Professional	TC	$38.86	$46.03	$107.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.40 / $119.34 / $149.18	Professional		$57.40	$119.34	$149.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.92 / $23.73 / $31.23	Professional	26	$12.92	$23.73	$31.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.46 / $95.61 / $119.52	Professional	TC	$44.46	$95.61	$119.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $51.50 / $75.73 / $161.88	Professional		$51.50	$75.73	$161.88
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.14 / $16.73 / $64.72	Professional	26	$11.14	$16.73	$64.72
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.36 / $56.07 / $112.62	Professional	TC	$40.36	$56.07	$112.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $27.92 / $80.00 / $80.00	Facility	26	$27.92	$80.00	$80.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $59.95 / $102.54 / $346.85	Professional		$59.95	$102.54	$346.85
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.97 / $22.60 / $74.58	Professional	26	$13.97	$22.60	$74.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $43.47 / $70.31 / $272.27	Professional	TC	$43.47	$70.31	$272.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.01 / $106.15 / $138.08	Professional		$77.01	$106.15	$138.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.43 / $57.78 / $103.14	Professional		$12.43	$57.78	$103.14
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $87.90 / $135.87	Professional		$54.95	$87.90	$135.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.37 / $19.44 / $32.69	Professional	26	$13.37	$19.44	$32.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.87 / $64.45 / $100.04	Professional	TC	$41.87	$64.45	$100.04
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $84.69 / $107.20 / $126.10	Professional		$84.69	$107.20	$126.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.46 / $22.10 / $26.00	Professional	26	$17.46	$22.10	$26.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $67.23 / $85.10 / $100.10	Professional	TC	$67.23	$85.10	$100.10