Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $132.50 / $705.78 / $2,264.13	Facility		$132.50	$705.78	$2,264.13
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.15 / $135.65 / $264.64	Facility	26	$73.15	$135.65	$264.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.47 / $197.03 / $259.52	Professional		$130.47	$197.03	$259.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.81 / $71.40 / $189.24	Professional	26	$51.81	$71.40	$189.24
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $64.30 / $71.33 / $117.97	Professional	52	$64.30	$71.33	$117.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.07 / $81.38 / $202.54	Professional	TC	$59.07	$81.38	$202.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $633.17 / $652.17 / $671.17	Facility		$633.17	$652.17	$671.17
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.19 / $172.21 / $177.22	Facility	26	$167.19	$172.21	$177.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.09 / $349.86 / $522.54	Professional		$175.09	$349.86	$522.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.30 / $176.86 / $221.07	Professional	26	$66.30	$176.86	$221.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.15 / $164.33 / $385.87	Professional	TC	$99.15	$164.33	$385.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $133.19 / $239.84 / $904.62	Professional		$133.19	$239.84	$904.62
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.87 / $103.62 / $378.75	Professional	26	$75.87	$103.62	$378.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.33 / $107.44 / $753.03	Professional	TC	$57.33	$107.44	$753.03
Medica Facility/Professional Facility Modifier Low / Median / High Price $212.02 / $457.03 / $4,907.85	Facility		$212.02	$457.03	$4,907.85
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $188.75 / $366.35 / $366.35	Facility	26	$188.75	$366.35	$366.35
Medica Facility/Professional Professional Modifier Low / Median / High Price $168.76 / $299.42 / $3,102.49	Professional		$168.76	$299.42	$3,102.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $66.26 / $107.09 / $551.37	Professional	26	$66.26	$107.09	$551.37
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $78.30 / $133.74 / $2,808.09	Professional	TC	$78.30	$133.74	$2,808.09
Midlands Facility/Professional Facility Modifier Low / Median / High Price $277.81 / $349.86 / $671.17	Facility		$277.81	$349.86	$671.17
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $172.21 / $177.22 / $438.60	Facility	26	$172.21	$177.22	$438.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $277.81 / $349.86 / $805.00	Professional		$277.81	$349.86	$805.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $68.80 / $125.34 / $255.63	Professional		$68.80	$125.34	$255.63
United Facility/Professional Professional Modifier Low / Median / High Price $158.74 / $199.78 / $328.84	Professional		$158.74	$199.78	$328.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.03 / $101.98 / $167.93	Professional	26	$70.03	$101.98	$167.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $71.18 / $92.69 / $208.63	Professional	TC	$71.18	$92.69	$208.63
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $200.27 / $253.50 / $298.20	Professional		$200.27	$253.50	$298.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $109.18 / $138.19 / $162.60	Professional	26	$109.18	$138.19	$162.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $91.09 / $115.30 / $135.69	Professional	TC	$91.09	$115.30	$135.69