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 Professional Modifier Low / Median / High Price $197.75 / $425.00 / $1,603.00	Professional		$197.75	$425.00	$1,603.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.00 / $128.00 / $341.00	Professional	26	$68.00	$128.00	$341.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.84 / $125.00 / $237.50	Professional	52	$97.84	$125.00	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.54 / $244.58 / $432.43	Professional	TC	$124.54	$244.58	$432.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $238.05 / $245.19 / $252.33	Facility	26	$238.05	$245.19	$252.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $314.16 / $525.87 / $1,089.25	Professional		$314.16	$525.87	$1,089.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.29 / $159.02 / $237.53	Professional	26	$74.29	$159.02	$237.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.88 / $343.48 / $892.76	Professional	TC	$203.88	$343.48	$892.76
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $170.53 / $315.18 / $1,376.04	Professional		$170.53	$315.18	$1,376.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.26 / $107.36 / $242.47	Professional	26	$65.26	$107.36	$242.47
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.27 / $197.78 / $1,160.11	Professional	TC	$105.27	$197.78	$1,160.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $510.16 / $656.72 / $656.72	Facility	26	$510.16	$656.72	$656.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $244.08 / $438.59 / $2,901.82	Professional		$244.08	$438.59	$2,901.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $77.84 / $123.49 / $558.07	Professional	26	$77.84	$123.49	$558.07
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $156.91 / $261.52 / $2,498.98	Professional	TC	$156.91	$261.52	$2,498.98
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $245.19 / $252.33 / $389.22	Facility	26	$245.19	$252.33	$389.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $371.99 / $485.06 / $893.00	Professional		$371.99	$485.06	$893.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.04 / $180.48 / $318.93	Professional		$70.04	$180.48	$318.93
United Facility/Professional Professional Modifier Low / Median / High Price $220.51 / $333.58 / $631.98	Professional		$220.51	$333.58	$631.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $108.96 / $222.43	Professional	26	$75.65	$108.96	$222.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.84 / $214.45 / $430.97	Professional	TC	$143.84	$214.45	$430.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $341.12 / $431.80 / $508.00	Professional		$341.12	$431.80	$508.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $122.92 / $155.60 / $183.00	Professional	26	$122.92	$155.60	$183.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $218.20 / $276.20 / $324.89	Professional	TC	$218.20	$276.20	$324.89