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 / $427.67	Facility	26	$76.39	$156.99	$427.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.12 / $385.88 / $1,634.16	Professional		$251.12	$385.88	$1,634.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.08 / $88.35 / $398.40	Professional	26	$74.08	$88.35	$398.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.49 / $259.47 / $623.14	Professional	TC	$168.49	$259.47	$623.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $264.93 / $272.88 / $280.83	Facility	26	$264.93	$272.88	$280.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $456.72 / $658.57 / $1,446.64	Professional		$456.72	$658.57	$1,446.64
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 $326.54 / $486.59 / $1,233.06	Professional	TC	$326.54	$486.59	$1,233.06
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $245.66 / $421.40 / $1,335.80	Professional		$245.66	$421.40	$1,335.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.84 / $126.04 / $286.64	Professional	26	$76.84	$126.04	$286.64
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $168.82 / $296.77 / $1,059.56	Professional	TC	$168.82	$296.77	$1,059.56
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 $304.64 / $553.90 / $3,248.56	Professional		$304.64	$553.90	$3,248.56
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $88.74 / $123.11 / $880.00	Professional	26	$88.74	$123.11	$880.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $210.62 / $369.54 / $2,762.21	Professional	TC	$210.62	$369.54	$2,762.21
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $272.88 / $280.83 / $459.06	Facility	26	$272.88	$280.83	$459.06
Midlands Facility/Professional Professional Modifier Low / Median / High Price $487.29 / $617.29 / $944.34	Professional		$487.29	$617.29	$944.34
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.39 / $200.37 / $459.55	Professional		$82.39	$200.37	$459.55
United Facility/Professional Professional Modifier Low / Median / High Price $288.49 / $360.64 / $644.61	Professional		$288.49	$360.64	$644.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.63 / $102.58 / $194.11	Professional	26	$85.63	$102.58	$194.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $210.62 / $249.33 / $500.44	Professional	TC	$210.62	$249.33	$500.44
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $426.36 / $539.70 / $635.00	Professional		$426.36	$539.70	$635.00
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 $301.62 / $381.80 / $449.20	Professional	TC	$301.62	$381.80	$449.20