Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.18 / $96.91 / $155.41	Facility	26	$47.18	$96.91	$155.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.43 / $221.75 / $859.00	Professional		$133.43	$221.75	$859.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.90 / $55.00 / $189.00	Professional	26	$46.90	$55.00	$189.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $66.72 / $83.68 / $137.50	Professional	52	$66.72	$83.68	$137.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.42 / $174.20 / $281.80	Professional	TC	$82.42	$174.20	$281.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $151.58 / $156.13 / $160.66	Facility	26	$151.58	$156.13	$160.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $198.32 / $354.20 / $590.90	Professional		$198.32	$354.20	$590.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.03 / $116.36 / $173.32	Professional	26	$54.03	$116.36	$173.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.79 / $233.09 / $465.60	Professional	TC	$138.79	$233.09	$465.60
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $119.26 / $220.39 / $768.50	Professional		$119.26	$220.39	$768.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.47 / $77.31 / $180.21	Professional	26	$47.47	$77.31	$180.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.78 / $134.97 / $595.27	Professional	TC	$71.78	$134.97	$595.27
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $371.04 / $479.84 / $479.84	Facility	26	$371.04	$479.84	$479.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $163.36 / $288.20 / $1,609.32	Professional		$163.36	$288.20	$1,609.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $58.10 / $84.86 / $394.61	Professional	26	$58.10	$84.86	$394.61
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $100.99 / $176.94 / $1,384.00	Professional	TC	$100.99	$176.94	$1,384.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $156.13 / $160.66 / $284.22	Facility	26	$156.13	$160.66	$284.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $256.14 / $351.59 / $505.00	Professional		$256.14	$351.59	$505.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.92 / $113.79 / $222.79	Professional		$50.92	$113.79	$222.79
United Facility/Professional Professional Modifier Low / Median / High Price $155.94 / $193.39 / $338.60	Professional		$155.94	$193.39	$338.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.70 / $73.84 / $129.28	Professional	26	$56.70	$73.84	$129.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.34 / $119.55 / $221.34	Professional	TC	$96.34	$119.55	$221.34
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $205.32 / $259.89 / $305.80	Professional		$205.32	$259.89	$305.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $77.03 / $97.50 / $114.80	Professional	26	$77.03	$97.50	$114.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $128.30 / $162.40 / $191.00	Professional	TC	$128.30	$162.40	$191.00