Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.17 / $138.57 / $185.70	Facility	26	$46.17	$138.57	$185.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.93 / $185.43 / $809.00	Professional		$86.93	$185.43	$809.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.78 / $66.15 / $260.00	Professional	26	$41.78	$66.15	$260.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $42.71 / $61.78 / $379.08	Professional	52	$42.71	$61.78	$379.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $85.14 / $390.48	Professional	TC	$44.43	$85.14	$390.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.06 / $248.82 / $461.33	Professional		$199.06	$248.82	$461.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.86 / $109.82 / $155.19	Professional	26	$87.86	$109.82	$155.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $111.20 / $139.00 / $306.13	Professional	TC	$111.20	$139.00	$306.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $85.46 / $132.56 / $355.10	Professional		$85.46	$132.56	$355.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $40.33 / $66.45 / $255.82	Professional	26	$40.33	$66.45	$255.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.13 / $79.89 / $307.58	Professional	TC	$45.13	$79.89	$307.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $166.29 / $284.94 / $3,000.00	Professional		$166.29	$284.94	$3,000.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.75 / $117.77 / $870.13	Professional	26	$66.75	$117.77	$870.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $91.14 / $170.13 / $870.13	Professional	TC	$91.14	$170.13	$870.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $194.54 / $252.42 / $354.00	Professional		$194.54	$252.42	$354.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $45.07 / $86.93 / $174.04	Professional		$45.07	$86.93	$174.04
United Facility/Professional Professional Modifier Low / Median / High Price $127.01 / $231.92 / $353.88	Professional		$127.01	$231.92	$353.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.18 / $100.34 / $133.71	Professional	26	$51.18	$100.34	$133.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.53 / $147.04 / $211.93	Professional	TC	$72.53	$147.04	$211.93
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $151.84 / $192.20 / $226.10	Professional		$151.84	$192.20	$226.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $68.02 / $86.10 / $101.30	Professional	26	$68.02	$86.10	$101.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $83.82 / $106.10 / $124.80	Professional	TC	$83.82	$106.10	$124.80