Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.38 / $23.25 / $23.25	Facility	26	$10.38	$23.25	$23.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.91 / $68.38 / $264.47	Professional		$51.91	$68.38	$264.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.19 / $9.86 / $45.74	Professional	26	$8.19	$9.86	$45.74
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.59 / $30.20 / $152.36	Professional	52	$21.59	$30.20	$152.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.78 / $51.44 / $118.74	Professional	TC	$41.78	$51.44	$118.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.16 / $118.64 / $148.30	Professional		$60.16	$118.64	$148.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.32 / $17.45 / $21.81	Professional	26	$9.32	$17.45	$21.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.92 / $101.20 / $126.49	Professional	TC	$49.92	$101.20	$126.49
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $50.30 / $72.98 / $174.95	Professional		$50.30	$72.98	$174.95
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.14 / $12.11 / $59.46	Professional	26	$8.14	$12.11	$59.46
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.29 / $59.20 / $131.88	Professional	TC	$40.29	$59.20	$131.88
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $20.60 / $80.00 / $80.00	Facility	26	$20.60	$80.00	$80.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.49 / $105.42 / $373.69	Professional		$61.49	$105.42	$373.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.92 / $16.62 / $55.28	Professional	26	$9.92	$16.62	$55.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $49.86 / $80.41 / $318.41	Professional	TC	$49.86	$80.41	$318.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $79.20 / $107.70 / $141.02	Professional		$79.20	$107.70	$141.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.73 / $58.26 / $103.99	Professional		$9.73	$58.26	$103.99
United Facility/Professional Professional Modifier Low / Median / High Price $57.56 / $83.73 / $138.50	Professional		$57.56	$83.73	$138.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.35 / $23.74	Professional	26	$9.55	$14.35	$23.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.69 / $69.38 / $114.76	Professional	TC	$47.69	$69.38	$114.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.66 / $105.90 / $124.60	Professional		$83.66	$105.90	$124.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $12.96 / $16.39 / $19.30	Professional	26	$12.96	$16.39	$19.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.70 / $89.50 / $105.30	Professional	TC	$70.70	$89.50	$105.30