Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.70 / $162.84 / $278.10	Facility	26	$85.70	$162.84	$278.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $254.20 / $392.89 / $1,757.00	Professional		$254.20	$392.89	$1,757.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.05 / $96.89 / $395.65	Professional	26	$79.05	$96.89	$395.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.49 / $230.02 / $512.30	Professional	TC	$168.49	$230.02	$512.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $284.08 / $292.61 / $301.14	Facility	26	$284.08	$292.61	$301.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $375.52 / $672.53 / $1,120.57	Professional		$375.52	$672.53	$1,120.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.59 / $195.48 / $267.76	Professional	26	$91.59	$195.48	$267.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $298.80 / $477.06 / $885.64	Professional	TC	$298.80	$477.06	$885.64
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $251.07 / $431.24 / $1,412.14	Professional		$251.07	$431.24	$1,412.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.26 / $131.24 / $302.76	Professional	26	$80.26	$131.24	$302.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $170.81 / $300.26 / $1,053.11	Professional	TC	$170.81	$300.26	$1,053.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $627.76 / $804.96 / $804.96	Facility	26	$627.76	$804.96	$804.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $311.75 / $551.13 / $3,183.14	Professional		$311.75	$551.13	$3,183.14
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $93.24 / $133.49 / $1,009.00	Professional	26	$93.24	$133.49	$1,009.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $213.86 / $375.23 / $2,699.58	Professional	TC	$213.86	$375.23	$2,699.58
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $292.61 / $301.14 / $477.06	Facility	26	$292.61	$301.14	$477.06
Midlands Facility/Professional Professional Modifier Low / Median / High Price $493.47 / $648.00 / $924.30	Professional		$493.47	$648.00	$924.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.35 / $202.02 / $470.42	Professional		$86.35	$202.02	$470.42
United Facility/Professional Professional Modifier Low / Median / High Price $289.11 / $369.06 / $639.79	Professional		$289.11	$369.06	$639.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $90.73 / $111.73 / $202.90	Professional	26	$90.73	$111.73	$202.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $213.86 / $276.89 / $1,222.85	Professional	TC	$213.86	$276.89	$1,222.85
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $435.53 / $551.29 / $648.50	Professional		$435.53	$551.29	$648.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $130.27 / $164.90 / $194.00	Professional	26	$130.27	$164.90	$194.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $305.18 / $386.30 / $454.50	Professional	TC	$305.18	$386.30	$454.50