Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $251.19 / $457.09	Facility	26	$117.49	$251.19	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $870.96 / $3,467.37	Professional		$588.84	$870.96	$3,467.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $204.17 / $645.65	Professional	26	$114.82	$204.17	$645.65
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $213.80 / $645.65	Professional	52	$199.53	$213.80	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $660.69 / $1,445.44	Professional	TC	$467.74	$660.69	$1,445.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,479.11 / $1,698.24	Professional		$1,230.27	$1,479.11	$1,698.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $281.84 / $316.23	Professional	26	$239.88	$281.84	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $977.24 / $1,174.90 / $1,412.54	Professional	TC	$977.24	$1,174.90	$1,412.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $912.01 / $3,388.44	Professional		$575.44	$912.01	$3,388.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $204.17 / $741.31	Professional	26	$117.49	$204.17	$741.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $741.31 / $2,951.21	Professional	TC	$489.78	$741.31	$2,951.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $758.58 / $758.58 / $758.58	Facility	26	$758.58	$758.58	$758.58
Medica Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,348.96 / $6,165.95	Professional		$851.14	$1,348.96	$6,165.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $281.84 / $1,071.52	Professional	26	$158.49	$281.84	$1,071.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $645.65 / $1,047.13 / $3,890.45	Professional	TC	$645.65	$1,047.13	$3,890.45
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,659.59 / $1,819.70	Professional		$1,479.11	$1,659.59	$1,819.70
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $316.23 / $380.19	Professional	26	$281.84	$316.23	$380.19
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,348.96 / $1,445.44	Professional	TC	$1,174.90	$1,348.96	$1,445.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,288.25 / $1,698.24	Professional		$1,258.93	$1,288.25	$1,698.24
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $257.04 / $331.13	Professional	26	$239.88	$257.04	$331.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,071.52 / $1,348.96	Professional	TC	$1,000.00	$1,071.52	$1,348.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $660.69 / $1,412.54	Professional		$128.82	$660.69	$1,412.54
United Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,174.90 / $1,737.80	Professional		$660.69	$1,174.90	$1,737.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $263.03 / $354.81	Professional	26	$138.04	$263.03	$354.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $933.25 / $1,380.38	Professional	TC	$524.81	$933.25	$1,380.38
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 $239.88 / $239.88 / $281.84	Professional	26	$239.88	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,071.52 / $1,071.52 / $1,258.93	Professional	TC	$1,071.52	$1,071.52	$1,258.93