Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $154.88 / $239.88	Facility	26	$154.88	$154.88	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,148.15 / $4,365.16	Professional		$707.95	$1,148.15	$4,365.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $213.80 / $831.76	Professional	26	$107.15	$213.80	$831.76
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $630.96 / $977.24 / $3,630.78	Professional	52	$630.96	$977.24	$3,630.78
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $398.11 / $426.58 / $1,698.24	Professional	53	$398.11	$426.58	$1,698.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $741.31 / $1,778.28	Professional	TC	$588.84	$741.31	$1,778.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,737.80 / $2,454.71	Professional		$933.25	$1,737.80	$2,454.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $288.40 / $467.74	Professional	26	$158.49	$288.40	$467.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $1,412.54 / $2,041.74	Professional	TC	$776.25	$1,412.54	$2,041.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $1,047.13 / $2,951.21	Professional		$616.60	$1,047.13	$2,951.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $416.87	Professional	26	$102.33	$186.21	$416.87
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $870.96 / $2,511.89	Professional	TC	$524.81	$870.96	$2,511.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $794.33 / $794.33 / $794.33	Facility	26	$794.33	$794.33	$794.33
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	53	$645.65	$645.65	$645.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,737.80 / $5,370.32	Professional		$1,047.13	$1,737.80	$5,370.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $295.12 / $1,047.13	Professional	26	$162.18	$295.12	$1,047.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $794.33 / $1,479.11 / $4,466.84	Professional	TC	$794.33	$1,479.11	$4,466.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,862.09 / $2,454.71	Professional		$1,659.59	$1,862.09	$2,454.71
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $288.40 / $426.58	Professional	26	$257.04	$288.40	$426.58
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,412.54 / $1,584.89 / $2,041.74	Professional	TC	$1,412.54	$1,584.89	$2,041.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,778.28 / $2,187.76	Professional		$1,621.81	$1,778.28	$2,187.76
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $275.42 / $316.23 / $426.58	Professional	26	$275.42	$316.23	$426.58
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.26 / $1,479.11 / $1,862.09	Professional	TC	$1,318.26	$1,479.11	$1,862.09
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $741.31 / $1,584.89	Professional		$123.03	$741.31	$1,584.89
United Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,380.38 / $2,290.87	Professional		$870.96	$1,380.38	$2,290.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $263.03 / $363.08	Professional	26	$131.83	$263.03	$363.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $1,096.48 / $1,862.09	Professional	TC	$741.31	$1,096.48	$1,862.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,548.82	Professional		$1,318.26	$1,318.26	$1,548.82
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $208.93 / $245.47	Professional	26	$208.93	$208.93	$245.47
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,096.48 / $1,096.48 / $1,318.26	Professional	TC	$1,096.48	$1,096.48	$1,318.26