Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $146.00 / $254.87 / $350.92	Facility		$146.00	$254.87	$350.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.21 / $55.51 / $89.71	Facility	26	$29.21	$55.51	$89.71
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.39 / $178.25 / $665.00	Professional		$118.39	$178.25	$665.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $23.46 / $55.51	Professional	26	$19.82	$23.46	$55.51
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.20 / $70.95 / $96.63	Professional	52	$59.20	$70.95	$96.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.57 / $142.62 / $204.22	Professional	TC	$98.57	$142.62	$204.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.06 / $311.35 / $532.25	Professional		$144.06	$311.35	$532.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.89 / $52.02 / $81.68	Professional	26	$22.89	$52.02	$81.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $119.01 / $259.33 / $450.57	Professional	TC	$119.01	$259.33	$450.57
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $114.97 / $175.88 / $466.21	Professional		$114.97	$175.88	$466.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.72 / $33.33 / $65.75	Professional	26	$19.72	$33.33	$65.75
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.51 / $145.47 / $403.39	Professional	TC	$92.51	$145.47	$403.39
Medica Facility/Professional Facility Modifier Low / Median / High Price $171.85 / $302.13 / $470.23	Facility		$171.85	$302.13	$470.23
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $176.87 / $176.87 / $176.87	Facility	26	$176.87	$176.87	$176.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $157.07 / $281.01 / $1,173.20	Professional		$157.07	$281.01	$1,173.20
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.35 / $44.08 / $310.41	Professional	26	$24.35	$44.08	$310.41
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $116.67 / $232.12 / $1,048.79	Professional	TC	$116.67	$232.12	$1,048.79
Midlands Facility/Professional Facility Modifier Low / Median / High Price $240.65 / $302.13 / $384.85	Facility		$240.65	$302.13	$384.85
Midlands Facility/Professional Professional Modifier Low / Median / High Price $186.00 / $286.76 / $359.12	Professional		$186.00	$286.76	$359.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $23.03 / $118.94 / $228.29	Professional		$23.03	$118.94	$228.29
United Facility/Professional Professional Modifier Low / Median / High Price $134.97 / $235.60 / $350.95	Professional		$134.97	$235.60	$350.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $38.82 / $60.80	Professional	26	$22.74	$38.82	$60.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.24 / $212.42 / $275.94	Professional	TC	$112.24	$212.42	$275.94
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $189.36 / $239.70 / $282.00	Professional		$189.36	$239.70	$282.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $30.65 / $38.79 / $45.70	Professional	26	$30.65	$38.79	$45.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $158.71 / $200.90 / $236.40	Professional	TC	$158.71	$200.90	$236.40