Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.45 / $76.84 / $129.74	Facility	26	$40.45	$76.84	$129.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.27 / $253.20 / $897.00	Professional		$128.27	$253.20	$897.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.27 / $57.85 / $199.00	Professional	26	$39.27	$57.85	$199.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.14 / $75.62 / $137.50	Professional	52	$64.14	$75.62	$137.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.82 / $177.61 / $430.98	Professional	TC	$87.82	$177.61	$430.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.37 / $174.45 / $179.53	Facility	26	$169.37	$174.45	$179.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $210.81 / $318.02 / $629.35	Professional		$210.81	$318.02	$629.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.40 / $92.31 / $139.54	Professional	26	$45.40	$92.31	$139.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.94 / $221.94 / $489.80	Professional	TC	$147.94	$221.94	$489.80
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $114.07 / $211.46 / $693.90	Professional		$114.07	$211.46	$693.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.75 / $67.95 / $179.18	Professional	26	$37.75	$67.95	$179.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.31 / $143.51 / $488.78	Professional	TC	$76.31	$143.51	$488.78
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $295.27 / $379.28 / $379.28	Facility	26	$295.27	$379.28	$379.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $143.13 / $259.19 / $1,413.47	Professional		$143.13	$259.19	$1,413.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.11 / $62.21 / $333.52	Professional	26	$46.11	$62.21	$333.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $97.02 / $169.23 / $1,220.00	Professional	TC	$97.02	$169.23	$1,220.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $174.45 / $179.53 / $225.24	Facility	26	$174.45	$179.53	$225.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $246.40 / $309.87 / $475.00	Professional		$246.40	$309.87	$475.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.61 / $116.83 / $213.24	Professional		$40.61	$116.83	$213.24
United Facility/Professional Professional Modifier Low / Median / High Price $137.71 / $169.44 / $302.88	Professional		$137.71	$169.44	$302.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.96 / $54.59 / $104.80	Professional	26	$43.96	$54.59	$104.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $92.57 / $132.30 / $239.90	Professional	TC	$92.57	$132.30	$239.90
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $197.74 / $250.30 / $294.39	Professional		$197.74	$250.30	$294.39
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $61.38 / $77.70 / $91.40	Professional	26	$61.38	$77.70	$91.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $136.35 / $172.60 / $203.10	Professional	TC	$136.35	$172.60	$203.10