Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.34 / $236.26 / $439.45	Facility	26	$124.34	$236.26	$439.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $563.67 / $800.97 / $2,987.76	Professional		$563.67	$800.97	$2,987.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.55 / $184.72 / $618.00	Professional	26	$112.55	$184.72	$618.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $246.22 / $309.93 / $1,648.11	Professional	52	$246.22	$309.93	$1,648.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $451.13 / $634.95 / $2,000.00	Professional	TC	$451.13	$634.95	$2,000.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,132.91 / $1,444.02 / $1,745.10	Professional		$1,132.91	$1,444.02	$1,745.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $223.62 / $279.50 / $321.43	Professional	26	$223.62	$279.50	$321.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $897.75 / $1,142.48 / $1,356.93	Professional	TC	$897.75	$1,142.48	$1,356.93
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $543.83 / $870.25 / $2,673.01	Professional		$543.83	$870.25	$2,673.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $108.48 / $174.15 / $557.88	Professional	26	$108.48	$174.15	$557.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $435.35 / $699.96 / $2,115.13	Professional	TC	$435.35	$699.96	$2,115.13
Medica Facility/Professional Professional Modifier Low / Median / High Price $848.03 / $1,363.78 / $6,200.00	Professional		$848.03	$1,363.78	$6,200.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $162.86 / $279.62 / $2,600.00	Professional	26	$162.86	$279.62	$2,600.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $644.17 / $1,044.31 / $7,000.00	Professional	TC	$644.17	$1,044.31	$7,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $907.33 / $1,294.74 / $1,641.09	Professional		$907.33	$1,294.74	$1,641.09
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $120.55 / $618.86 / $1,122.52	Professional		$120.55	$618.86	$1,122.52
United Facility/Professional Professional Modifier Low / Median / High Price $653.48 / $1,134.21 / $1,545.61	Professional		$653.48	$1,134.21	$1,545.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.72 / $246.41 / $325.72	Professional	26	$131.72	$246.41	$325.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $493.40 / $791.50 / $1,219.89	Professional	TC	$493.40	$791.50	$1,219.89
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $991.53 / $1,255.09 / $1,476.60	Professional		$991.53	$1,255.09	$1,476.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $182.89 / $231.50 / $272.39	Professional	26	$182.89	$231.50	$272.39
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $808.64 / $1,023.60 / $1,204.20	Professional	TC	$808.64	$1,023.60	$1,204.20