Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.81 / $128.83 / $206.62	Facility	26	$67.81	$128.83	$206.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $126.00 / $322.79 / $1,423.00	Professional		$126.00	$322.79	$1,423.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.14 / $126.00 / $322.00	Professional	26	$62.14	$126.00	$322.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $103.71 / $125.00 / $237.50	Professional	52	$103.71	$125.00	$237.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.99 / $335.00 / $708.53	Professional	TC	$141.99	$335.00	$708.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $209.22 / $215.50 / $221.77	Facility	26	$209.22	$215.50	$221.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $336.22 / $564.37 / $1,167.56	Professional		$336.22	$564.37	$1,167.56
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 $235.08 / $412.42 / $999.55	Professional	TC	$235.08	$412.42	$999.55
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.07 / $335.36 / $1,390.61	Professional		$181.07	$335.36	$1,390.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.62 / $96.66 / $214.99	Professional	26	$59.62	$96.66	$214.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.45 / $227.99 / $1,211.43	Professional	TC	$121.45	$227.99	$1,211.43
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 $256.73 / $454.46 / $2,791.06	Professional		$256.73	$454.46	$2,791.06
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $68.26 / $116.08 / $525.38	Professional	26	$68.26	$116.08	$525.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $177.13 / $295.22 / $2,451.15	Professional	TC	$177.13	$295.22	$2,451.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $215.50 / $221.77 / $357.66	Facility	26	$215.50	$221.77	$357.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $390.43 / $506.71 / $873.32	Professional		$390.43	$506.71	$873.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.94 / $192.42 / $338.99	Professional		$63.94	$192.42	$338.99
United Facility/Professional Professional Modifier Low / Median / High Price $235.33 / $320.91 / $665.67	Professional		$235.33	$320.91	$665.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.66 / $99.50 / $203.61	Professional	26	$67.66	$99.50	$203.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.37 / $258.32 / $493.79	Professional	TC	$162.37	$258.32	$493.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $364.03 / $460.80 / $542.10	Professional		$364.03	$460.80	$542.10
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 $251.69 / $318.60 / $374.80	Professional	TC	$251.69	$318.60	$374.80