Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.90 / $138.79 / $358.55	Facility	26	$63.90	$138.79	$358.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $244.12 / $475.00 / $1,729.00	Professional		$244.12	$475.00	$1,729.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.42 / $126.00 / $282.00	Professional	26	$68.42	$126.00	$282.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $118.21 / $163.55 / $284.62	Professional	52	$118.21	$163.55	$284.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $166.60 / $305.00 / $557.00	Professional	TC	$166.60	$305.00	$557.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $221.48 / $228.12 / $234.77	Facility	26	$221.48	$228.12	$234.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $377.10 / $577.44 / $1,208.84	Professional		$377.10	$577.44	$1,208.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.25 / $156.69 / $217.93	Professional	26	$73.25	$156.69	$217.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $280.00 / $427.25 / $1,028.03	Professional	TC	$280.00	$427.25	$1,028.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $202.79 / $347.69 / $1,342.67	Professional		$202.79	$347.69	$1,342.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.33 / $105.45 / $266.26	Professional	26	$64.33	$105.45	$266.26
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.46 / $243.20 / $1,146.36	Professional	TC	$138.46	$243.20	$1,146.36
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $502.88 / $650.32 / $650.32	Facility	26	$502.88	$650.32	$650.32
Medica Facility/Professional Professional Modifier Low / Median / High Price $298.00 / $496.66 / $3,507.01	Professional		$298.00	$496.66	$3,507.01
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $73.75 / $121.70 / $571.29	Professional	26	$73.75	$121.70	$571.29
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $212.09 / $353.48 / $2,477.29	Professional	TC	$212.09	$353.48	$2,477.29
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $228.12 / $234.77 / $385.32	Facility	26	$228.12	$234.77	$385.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $602.19 / $884.61	Professional		$446.68	$602.19	$884.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.66 / $232.57 / $399.27	Professional		$69.66	$232.57	$399.27
United Facility/Professional Professional Modifier Low / Median / High Price $270.31 / $429.32 / $772.34	Professional		$270.31	$429.32	$772.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.22 / $107.39 / $216.22	Professional	26	$73.22	$107.39	$216.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $194.41 / $309.30 / $553.58	Professional	TC	$194.41	$309.30	$553.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $408.11 / $516.60 / $607.79	Professional		$408.11	$516.60	$607.79
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $121.19 / $153.40 / $180.40	Professional	26	$121.19	$153.40	$180.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $287.01 / $363.30 / $427.40	Professional	TC	$287.01	$363.30	$427.40