Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.15 / $129.47 / $207.62	Facility	26	$68.15	$129.47	$207.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.19 / $322.79 / $1,423.00	Professional		$140.19	$322.79	$1,423.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.55 / $126.31 / $314.92	Professional	26	$64.55	$126.31	$314.92
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $103.87 / $144.24 / $248.99	Professional	52	$103.87	$144.24	$248.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $142.55 / $335.00 / $631.87	Professional	TC	$142.55	$335.00	$631.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $206.70 / $212.90 / $219.10	Facility	26	$206.70	$212.90	$219.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $336.76 / $563.69 / $1,141.93	Professional		$336.76	$563.69	$1,141.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.81 / $145.83 / $202.83	Professional	26	$67.81	$145.83	$202.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $235.62 / $394.41 / $973.92	Professional	TC	$235.62	$394.41	$973.92
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.36 / $335.88 / $1,375.14	Professional		$181.36	$335.88	$1,375.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.62 / $96.66 / $215.00	Professional	26	$59.62	$96.66	$215.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.73 / $228.51 / $1,195.98	Professional	TC	$121.73	$228.51	$1,195.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $466.08 / $603.28 / $603.28	Facility	26	$466.08	$603.28	$603.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $257.48 / $453.56 / $2,789.74	Professional		$257.48	$453.56	$2,789.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $68.25 / $115.23 / $542.85	Professional	26	$68.25	$115.23	$542.85
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $177.12 / $295.20 / $2,451.15	Professional	TC	$177.12	$295.20	$2,451.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $212.90 / $219.10 / $357.66	Facility	26	$212.90	$219.10	$357.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $391.05 / $506.00 / $874.04	Professional		$391.05	$506.00	$874.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.55 / $210.07 / $353.53	Professional		$66.55	$210.07	$353.53
United Facility/Professional Professional Modifier Low / Median / High Price $236.03 / $375.08 / $665.67	Professional		$236.03	$375.08	$665.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $93.59 / $178.81	Professional	26	$66.86	$93.59	$178.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.97 / $228.38 / $487.48	Professional	TC	$154.97	$228.38	$487.48
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $364.59 / $461.50 / $543.00	Professional		$364.59	$461.50	$543.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $112.34 / $142.19 / $167.30	Professional	26	$112.34	$142.19	$167.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $252.33 / $319.39 / $375.70	Professional	TC	$252.33	$319.39	$375.70