Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.12 / $140.82 / $225.23	Facility	26	$74.12	$140.82	$225.23
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $53.24 / $94.38 / $163.51	Facility	53	$53.24	$94.38	$163.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.32 / $396.26 / $1,453.26	Professional		$203.32	$396.26	$1,453.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.88 / $114.48 / $363.16	Professional	26	$65.88	$114.48	$363.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $100.60 / $139.63 / $237.50	Professional	52	$100.60	$139.63	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.11 / $261.07 / $423.50	Professional	TC	$130.11	$261.07	$423.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $217.16 / $223.67 / $230.19	Facility	26	$217.16	$223.67	$230.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $324.38 / $542.98 / $1,215.98	Professional		$324.38	$542.98	$1,215.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.95 / $158.24 / $221.00	Professional	26	$73.95	$158.24	$221.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.64 / $359.34 / $1,036.57	Professional	TC	$214.64	$359.34	$1,036.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $175.63 / $324.79 / $1,444.61	Professional		$175.63	$324.79	$1,444.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.98 / $105.48 / $245.54	Professional	26	$64.98	$105.48	$245.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.66 / $207.93 / $1,247.81	Professional	TC	$110.66	$207.93	$1,247.81
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $507.76 / $656.72 / $656.72	Facility	26	$507.76	$656.72	$656.72
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $285.58 / $285.58 / $285.58	Facility	53	$285.58	$285.58	$285.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $250.55 / $451.14 / $2,872.81	Professional		$250.55	$451.14	$2,872.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $74.98 / $127.12 / $584.49	Professional	26	$74.98	$127.12	$584.49
Medica Facility/Professional Professional Modifier 52 Low / Median / High Price $1,051.34 / $1,051.34 / $2,138.50	Professional	52	$1,051.34	$1,051.34	$2,138.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $163.38 / $272.30 / $2,498.98	Professional	TC	$163.38	$272.30	$2,498.98
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $223.67 / $230.19 / $389.22	Facility	26	$223.67	$230.19	$389.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $381.82 / $488.97 / $886.43	Professional		$381.82	$488.97	$886.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $184.75 / $328.48	Professional		$69.70	$184.75	$328.48
United Facility/Professional Professional Modifier Low / Median / High Price $215.31 / $365.38 / $588.84	Professional		$215.31	$365.38	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.98 / $106.61 / $215.32	Professional	26	$74.98	$106.61	$215.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.77 / $223.29 / $490.99	Professional	TC	$149.77	$223.29	$490.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $351.71 / $445.20 / $523.70	Professional		$351.71	$445.20	$523.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $122.29 / $154.80 / $182.20	Professional	26	$122.29	$154.80	$182.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $229.34 / $290.30 / $341.60	Professional	TC	$229.34	$290.30	$341.60