Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.67 / $189.07 / $220.10	Facility	26	$78.67	$189.07	$220.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $354.84 / $393.64 / $801.50	Professional		$354.84	$393.64	$801.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.38 / $62.28 / $122.98	Professional	26	$55.38	$62.28	$122.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $177.42 / $196.82 / $269.69	Professional	52	$177.42	$196.82	$269.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $299.45 / $331.36 / $668.76	Professional	TC	$299.45	$331.36	$668.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $701.10 / $938.37 / $1,250.15	Professional		$701.10	$938.37	$1,250.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.21 / $138.00 / $155.19	Professional	26	$114.21	$138.00	$155.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $670.92 / $803.58 / $1,094.95	Professional	TC	$670.92	$803.58	$1,094.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $357.61 / $594.50 / $2,461.41	Professional		$357.61	$594.50	$2,461.41
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.22 / $86.81 / $374.79	Professional	26	$54.22	$86.81	$374.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $303.39 / $510.48 / $2,086.62	Professional	TC	$303.39	$510.48	$2,086.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $566.94 / $914.00 / $2,899.13	Professional		$566.94	$914.00	$2,899.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $81.61 / $141.55 / $873.43	Professional	26	$81.61	$141.55	$873.43
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $458.40 / $761.40 / $2,483.58	Professional	TC	$458.40	$761.40	$2,483.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $675.40 / $910.28 / $1,061.88	Professional		$675.40	$910.28	$1,061.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.23 / $406.47 / $741.61	Professional		$60.23	$406.47	$741.61
United Facility/Professional Professional Modifier Low / Median / High Price $434.65 / $842.85 / $1,028.05	Professional		$434.65	$842.85	$1,028.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.81 / $135.38 / $182.13	Professional	26	$69.81	$135.38	$182.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $369.09 / $715.37 / $1,039.02	Professional	TC	$369.09	$715.37	$1,039.02
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $654.66 / $828.70 / $975.00	Professional		$654.66	$828.70	$975.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $91.17 / $115.40 / $135.80	Professional	26	$91.17	$115.40	$135.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $563.51 / $713.30 / $839.20	Professional	TC	$563.51	$713.30	$839.20