Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.39 / $156.99 / $429.28	Facility	26	$76.39	$156.99	$429.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.12 / $385.88 / $1,699.97	Professional		$251.12	$385.88	$1,699.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.65 / $91.53 / $405.68	Professional	26	$75.65	$91.53	$405.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.49 / $230.02 / $509.48	Professional	TC	$168.49	$230.02	$509.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $266.33 / $274.33 / $282.32	Facility	26	$266.33	$274.33	$282.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $457.26 / $659.35 / $1,409.62	Professional		$457.26	$659.35	$1,409.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.43 / $187.72 / $257.13	Professional	26	$87.43	$187.72	$257.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $327.07 / $487.39 / $1,194.61	Professional	TC	$327.07	$487.39	$1,194.61
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $245.95 / $421.89 / $1,335.80	Professional		$245.95	$421.89	$1,335.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.84 / $126.04 / $307.58	Professional	26	$76.84	$126.04	$307.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.11 / $297.27 / $1,100.24	Professional	TC	$169.11	$297.27	$1,100.24
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $600.40 / $773.84 / $773.84	Facility	26	$600.40	$773.84	$773.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $305.01 / $554.00 / $3,234.12	Professional		$305.01	$554.00	$3,234.12
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $88.33 / $125.30 / $559.72	Professional	26	$88.33	$125.30	$559.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $210.98 / $370.17 / $2,749.60	Professional	TC	$210.98	$370.17	$2,749.60
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $274.33 / $282.32 / $459.06	Facility	26	$274.33	$282.32	$459.06
Midlands Facility/Professional Professional Modifier Low / Median / High Price $487.29 / $617.29 / $943.22	Professional		$487.29	$617.29	$943.22
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.39 / $200.37 / $459.87	Professional		$82.39	$200.37	$459.87
United Facility/Professional Professional Modifier Low / Median / High Price $298.89 / $361.07 / $641.85	Professional		$298.89	$361.07	$641.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.63 / $107.40 / $196.42	Professional	26	$85.63	$107.40	$196.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $210.98 / $273.75 / $1,419.30	Professional	TC	$210.98	$273.75	$1,419.30
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $426.92 / $540.40 / $635.70	Professional		$426.92	$540.40	$635.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $124.74 / $157.90 / $185.70	Professional	26	$124.74	$157.90	$185.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $302.18 / $382.50 / $450.00	Professional	TC	$302.18	$382.50	$450.00