Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.95 / $169.53 / $437.98	Facility	26	$77.95	$169.53	$437.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.69 / $425.00 / $700.00	Professional		$277.69	$425.00	$700.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.75 / $127.89 / $214.08	Professional	26	$84.75	$127.89	$214.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $138.18 / $193.04 / $350.00	Professional	52	$138.18	$193.04	$350.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $191.40 / $299.00 / $385.92	Professional	TC	$191.40	$299.00	$385.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $263.67 / $271.58 / $279.49	Facility	26	$263.67	$271.58	$279.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $404.67 / $656.40 / $1,358.36	Professional		$404.67	$656.40	$1,358.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.16 / $191.60 / $262.39	Professional	26	$89.16	$191.60	$262.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $284.27 / $462.12 / $1,140.51	Professional	TC	$284.27	$462.12	$1,140.51
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $240.96 / $446.58 / $1,632.21	Professional		$240.96	$446.58	$1,632.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.38 / $127.07 / $372.79	Professional	26	$78.38	$127.07	$372.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.58 / $305.49 / $1,391.75	Professional	TC	$162.58	$305.49	$1,391.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $612.55 / $789.76 / $789.76	Facility	26	$612.55	$789.76	$789.76
Medica Facility/Professional Professional Modifier Low / Median / High Price $346.21 / $578.05 / $3,445.62	Professional		$346.21	$578.05	$3,445.62
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $90.47 / $146.10 / $672.00	Professional	26	$90.47	$146.10	$672.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $241.55 / $402.58 / $2,996.90	Professional	TC	$241.55	$402.58	$2,996.90
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $271.58 / $279.49 / $468.60	Facility	26	$271.58	$279.49	$468.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $527.15 / $656.40 / $1,069.00	Professional		$527.15	$656.40	$1,069.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $84.04 / $253.15 / $450.68	Professional		$84.04	$253.15	$450.68
United Facility/Professional Professional Modifier Low / Median / High Price $317.36 / $473.16 / $1,093.98	Professional		$317.36	$473.16	$1,093.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.22 / $127.84 / $259.76	Professional	26	$87.22	$127.84	$259.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $221.42 / $352.25 / $631.05	Professional	TC	$221.42	$352.25	$631.05
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $484.59 / $613.40 / $721.70	Professional		$484.59	$613.40	$721.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $147.65 / $186.90 / $219.80	Professional	26	$147.65	$186.90	$219.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $337.01 / $426.60 / $501.80	Professional	TC	$337.01	$426.60	$501.80