Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $340.38 / $535.22 / $535.22	Professional		$340.38	$535.22	$535.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.64 / $155.18 / $155.18	Professional	26	$97.64	$155.18	$155.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $242.74 / $380.04 / $380.04	Professional	TC	$242.74	$380.04	$380.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $743.09 / $828.69 / $997.25	Professional		$743.09	$828.69	$997.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $227.79 / $276.44 / $292.16	Professional	26	$227.79	$276.44	$292.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $515.27 / $593.15 / $705.09	Professional	TC	$515.27	$593.15	$705.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $298.31 / $466.26 / $710.56	Professional		$298.31	$466.26	$710.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.44 / $152.52 / $247.99	Professional	26	$97.44	$152.52	$247.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $200.87 / $313.74 / $378.58	Professional	TC	$200.87	$313.74	$378.58
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $473.80 / $473.80 / $473.80	Facility	26	$473.80	$473.80	$473.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $384.92 / $790.08 / $1,176.65	Professional		$384.92	$790.08	$1,176.65
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $125.09 / $252.26 / $785.60	Professional	26	$125.09	$252.26	$785.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $250.00 / $514.33 / $1,925.04	Professional	TC	$250.00	$514.33	$1,925.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $472.26 / $743.09 / $987.20	Professional		$472.26	$743.09	$987.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $594.40 / $998.00	Professional		$3.00	$594.40	$998.00
United Facility/Professional Professional Modifier Low / Median / High Price $353.78 / $658.30 / $1,062.79	Professional		$353.78	$658.30	$1,062.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $125.09 / $221.24 / $339.33	Professional	26	$125.09	$221.24	$339.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.20 / $495.07 / $723.46	Professional	TC	$251.20	$495.07	$723.46
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $655.20 / $655.20 / $770.90	Professional		$655.20	$655.20	$770.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $200.90 / $200.90 / $236.30	Professional	26	$200.90	$200.90	$236.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $454.40 / $454.40 / $534.50	Professional	TC	$454.40	$454.40	$534.50