Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.91 / $221.99 / $410.42	Facility	26	$118.91	$221.99	$410.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.35 / $440.24 / $784.47	Professional		$293.35	$440.24	$784.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.42 / $110.24 / $175.59	Professional	26	$68.42	$110.24	$175.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $222.87 / $330.00 / $472.35	Professional	TC	$222.87	$330.00	$472.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $215.66 / $222.13 / $228.60	Facility	26	$215.66	$222.13	$228.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $450.14 / $801.30 / $1,339.85	Professional		$450.14	$801.30	$1,339.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.25 / $156.69 / $215.10	Professional	26	$73.25	$156.69	$215.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $392.14 / $644.61 / $1,161.86	Professional	TC	$392.14	$644.61	$1,161.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $294.99 / $549.46 / $1,342.67	Professional		$294.99	$549.46	$1,342.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.33 / $107.36 / $252.92	Professional	26	$64.33	$107.36	$252.92
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $230.67 / $433.78 / $1,146.36	Professional	TC	$230.67	$433.78	$1,146.36
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $502.88 / $647.12 / $647.12	Facility	26	$502.88	$647.12	$647.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $442.15 / $678.89 / $3,077.22	Professional		$442.15	$678.89	$3,077.22
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $73.73 / $120.12 / $680.25	Professional	26	$73.73	$120.12	$680.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $356.24 / $519.52 / $2,677.57	Professional	TC	$356.24	$519.52	$2,677.57
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $222.13 / $228.60 / $383.52	Facility	26	$222.13	$228.60	$383.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $568.52 / $678.89 / $1,080.05	Professional		$568.52	$678.89	$1,080.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $427.30 / $427.30 / $1,502.10	Professional		$427.30	$427.30	$1,502.10
United Facility/Professional Professional Modifier Low / Median / High Price $407.81 / $624.94 / $1,945.64	Professional		$407.81	$624.94	$1,945.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.03 / $107.39 / $211.73	Professional	26	$73.03	$107.39	$211.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $326.56 / $458.76 / $933.15	Professional	TC	$326.56	$458.76	$933.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $599.29 / $758.60 / $892.40	Professional		$599.29	$758.60	$892.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $121.19 / $153.40 / $180.40	Professional	26	$121.19	$153.40	$180.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $478.11 / $605.20 / $712.00	Professional	TC	$478.11	$605.20	$712.00