Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $339.81 / $534.52 / $1,530.00	Professional		$339.81	$534.52	$1,530.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $101.56 / $143.57 / $506.88	Professional	26	$101.56	$143.57	$506.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $186.01 / $312.85 / $342.37	Professional	52	$186.01	$312.85	$342.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.43 / $254.34 / $580.83	Professional	TC	$229.43	$254.34	$580.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $739.44 / $824.41 / $995.30	Professional		$739.44	$824.41	$995.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $222.71 / $270.16 / $287.29	Professional	26	$222.71	$270.16	$287.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $516.74 / $599.61 / $708.01	Professional	TC	$516.74	$599.61	$708.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $296.85 / $463.14 / $978.00	Professional		$296.85	$463.14	$978.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.41 / $148.52 / $249.52	Professional	26	$95.41	$148.52	$249.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $201.44 / $314.63 / $572.91	Professional	TC	$201.44	$314.63	$572.91
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $463.23 / $463.23 / $463.23	Facility	26	$463.23	$463.23	$463.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $383.64 / $792.54 / $1,174.80	Professional		$383.64	$792.54	$1,174.80
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $123.36 / $248.78 / $770.56	Professional	26	$123.36	$248.78	$770.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $250.94 / $531.41 / $1,927.52	Professional	TC	$250.94	$531.41	$1,927.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $477.88 / $739.44 / $997.23	Professional		$477.88	$739.44	$997.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $591.50 / $1,005.80	Professional		$3.00	$591.50	$1,005.80
United Facility/Professional Professional Modifier Low / Median / High Price $364.02 / $766.10 / $1,077.28	Professional		$364.02	$766.10	$1,077.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $123.36 / $211.77 / $334.65	Professional	26	$123.36	$211.77	$334.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $233.80 / $469.95 / $742.63	Professional	TC	$233.80	$469.95	$742.63
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $652.00 / $652.00 / $767.10	Professional		$652.00	$652.00	$767.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $196.40 / $196.40 / $231.00	Professional	26	$196.40	$196.40	$231.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $455.60 / $455.60 / $536.00	Professional	TC	$455.60	$455.60	$536.00