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 / $226.23	Facility	26	$74.12	$140.82	$226.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $196.00 / $425.00 / $1,355.00	Professional		$196.00	$425.00	$1,355.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.59 / $118.04 / $362.12	Professional	26	$66.59	$118.04	$362.12
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.17 / $136.25 / $350.00	Professional	52	$98.17	$136.25	$350.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.81 / $299.00 / $557.00	Professional	TC	$124.81	$299.00	$557.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $221.22 / $227.86 / $234.49	Facility	26	$221.22	$227.86	$234.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $315.24 / $527.67 / $1,083.56	Professional		$315.24	$527.67	$1,083.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.29 / $159.02 / $221.17	Professional	26	$74.29	$159.02	$221.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.96 / $345.59 / $899.88	Professional	TC	$204.96	$345.59	$899.88
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $171.09 / $316.24 / $1,409.74	Professional		$171.09	$316.24	$1,409.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.26 / $105.98 / $224.49	Professional	26	$65.26	$105.98	$224.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.84 / $198.85 / $1,212.94	Professional	TC	$105.84	$198.85	$1,212.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $510.16 / $659.84 / $659.84	Facility	26	$510.16	$659.84	$659.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $244.48 / $445.55 / $3,145.84	Professional		$244.48	$445.55	$3,145.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $74.98 / $127.12 / $577.89	Professional	26	$74.98	$127.12	$577.89
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $156.83 / $262.18 / $2,772.01	Professional	TC	$156.83	$262.18	$2,772.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $227.86 / $234.49 / $391.02	Facility	26	$227.86	$234.49	$391.02
Midlands Facility/Professional Professional Modifier Low / Median / High Price $372.56 / $485.32 / $915.93	Professional		$372.56	$485.32	$915.93
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.04 / $181.40 / $320.00	Professional		$70.04	$181.40	$320.00
United Facility/Professional Professional Modifier Low / Median / High Price $217.20 / $356.53 / $683.44	Professional		$217.20	$356.53	$683.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.41 / $108.39 / $222.43	Professional	26	$74.41	$108.39	$222.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.19 / $214.99 / $446.06	Professional	TC	$144.19	$214.99	$446.06
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $342.31 / $433.30 / $509.70	Professional		$342.31	$433.30	$509.70
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 $219.38 / $277.70 / $326.70	Professional	TC	$219.38	$277.70	$326.70