Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.09 / $245.27 / $453.11	Facility	26	$129.09	$245.27	$453.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $589.29 / $855.66 / $3,434.00	Professional		$589.29	$855.66	$3,434.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.10 / $172.21 / $622.05	Professional	26	$115.10	$172.21	$622.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $258.77 / $324.08 / $434.65	Professional	52	$258.77	$324.08	$434.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $472.44 / $663.94 / $2,780.08	Professional	TC	$472.44	$663.94	$2,780.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,187.59 / $1,522.34 / $1,830.36	Professional		$1,187.59	$1,522.34	$1,830.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $238.97 / $290.43 / $344.70	Professional	26	$238.97	$290.43	$344.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $943.38 / $1,229.00 / $1,455.18	Professional	TC	$943.38	$1,229.00	$1,455.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $569.49 / $888.75 / $2,918.84	Professional		$569.49	$888.75	$2,918.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.15 / $182.49 / $514.29	Professional	26	$113.15	$182.49	$514.29
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $456.34 / $733.54 / $1,842.30	Professional	TC	$456.34	$733.54	$1,842.30
Medica Facility/Professional Professional Modifier Low / Median / High Price $890.67 / $1,455.85 / $6,200.00	Professional		$890.67	$1,455.85	$6,200.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $169.10 / $291.72 / $1,081.48	Professional	26	$169.10	$291.72	$1,081.48
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $679.81 / $1,097.43 / $3,875.48	Professional	TC	$679.81	$1,097.43	$3,875.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $952.79 / $1,363.86 / $1,713.05	Professional		$952.79	$1,363.86	$1,713.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $124.81 / $649.97 / $1,177.48	Professional		$124.81	$649.97	$1,177.48
United Facility/Professional Professional Modifier Low / Median / High Price $682.85 / $1,193.07 / $1,615.08	Professional		$682.85	$1,193.07	$1,615.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $142.99 / $261.12 / $338.20	Professional	26	$142.99	$261.12	$338.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $539.86 / $1,040.61 / $1,408.32	Professional	TC	$539.86	$1,040.61	$1,408.32
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,038.46 / $1,314.50 / $1,546.50	Professional		$1,038.46	$1,314.50	$1,546.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $190.79 / $241.50 / $284.20	Professional	26	$190.79	$241.50	$284.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $847.59 / $1,072.90 / $1,262.30	Professional	TC	$847.59	$1,072.90	$1,262.30