Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.43 / $217.43 / $349.04	Facility	26	$114.43	$217.43	$349.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $326.61 / $475.00 / $2,286.00	Professional		$326.61	$475.00	$2,286.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.52 / $164.09 / $562.00	Professional	26	$102.52	$164.09	$562.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $158.33 / $175.87 / $336.68	Professional	52	$158.33	$175.87	$336.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.21 / $335.00 / $689.03	Professional	TC	$217.21	$335.00	$689.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $350.10 / $360.60 / $371.11	Facility	26	$350.10	$360.60	$371.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $526.12 / $880.66 / $1,650.25	Professional		$526.12	$880.66	$1,650.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.52 / $245.90 / $356.00	Professional	26	$115.52	$245.90	$356.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $355.59 / $601.36 / $1,362.63	Professional	TC	$355.59	$601.36	$1,362.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $284.75 / $526.41 / $2,424.83	Professional		$284.75	$526.41	$2,424.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.17 / $165.32 / $382.06	Professional	26	$101.17	$165.32	$382.06
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.58 / $345.04 / $2,110.62	Professional	TC	$183.58	$345.04	$2,110.62
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $791.52 / $1,013.76 / $1,013.76	Facility	26	$791.52	$1,013.76	$1,013.76
Medica Facility/Professional Professional Modifier Low / Median / High Price $409.91 / $736.58 / $6,146.58	Professional		$409.91	$736.58	$6,146.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $117.29 / $196.26 / $921.60	Professional	26	$117.29	$196.26	$921.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $275.33 / $458.88 / $5,551.18	Professional	TC	$275.33	$458.88	$5,551.18
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $360.60 / $371.11 / $601.20	Facility	26	$360.60	$371.11	$601.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $621.42 / $784.34 / $1,597.00	Professional		$621.42	$784.34	$1,597.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $108.93 / $299.35 / $533.52	Professional		$108.93	$299.35	$533.52
United Facility/Professional Professional Modifier Low / Median / High Price $375.75 / $593.02 / $1,896.85	Professional		$375.75	$593.02	$1,896.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $115.63 / $168.23 / $341.62	Professional	26	$115.63	$168.23	$341.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $253.35 / $354.69 / $894.13	Professional	TC	$253.35	$354.69	$894.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $571.01 / $722.80 / $850.40	Professional		$571.01	$722.80	$850.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $241.20 / $283.80	Professional	26	$190.55	$241.20	$283.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $380.46 / $481.60 / $566.60	Professional	TC	$380.46	$481.60	$566.60