Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $170.16 / $170.16 / $437.98	Facility	26	$170.16	$170.16	$437.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $282.87 / $425.00 / $700.00	Professional		$282.87	$425.00	$700.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $126.00 / $183.44	Professional	26	$85.00	$126.00	$183.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $195.98 / $299.00 / $368.50	Professional	TC	$195.98	$299.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $285.30 / $293.86 / $302.42	Facility	26	$285.30	$293.86	$302.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $412.42 / $671.87 / $1,379.72	Professional		$412.42	$671.87	$1,379.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.48 / $193.15 / $263.41	Professional	26	$90.48	$193.15	$263.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $289.73 / $476.81 / $1,144.78	Professional	TC	$289.73	$476.81	$1,144.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $244.96 / $453.53 / $1,651.84	Professional		$244.96	$453.53	$1,651.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.25 / $129.53 / $440.41	Professional	26	$79.25	$129.53	$440.41
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $165.70 / $311.37 / $1,391.75	Professional	TC	$165.70	$311.37	$1,391.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $620.48 / $795.36 / $795.36	Facility	26	$620.48	$795.36	$795.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $353.68 / $589.46 / $3,482.54	Professional		$353.68	$589.46	$3,482.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $93.56 / $146.66 / $642.27	Professional	26	$93.56	$146.66	$642.27
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $248.09 / $414.36 / $2,996.90	Professional	TC	$248.09	$414.36	$2,996.90
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $293.86 / $302.42 / $471.00	Facility	26	$293.86	$302.42	$471.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $536.74 / $671.87 / $1,081.00	Professional		$536.74	$671.87	$1,081.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.39 / $258.14 / $459.10	Professional		$85.39	$258.14	$459.10
United Facility/Professional Professional Modifier Low / Median / High Price $324.20 / $512.77 / $914.54	Professional		$324.20	$512.77	$914.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.67 / $131.33 / $267.44	Professional	26	$91.67	$131.33	$267.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $209.01 / $311.30 / $647.10	Professional	TC	$209.01	$311.30	$647.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $492.80 / $623.79 / $733.90	Professional		$492.80	$623.79	$733.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $149.38 / $189.10 / $222.50	Professional	26	$149.38	$189.10	$222.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $343.41 / $434.70 / $511.50	Professional	TC	$343.41	$434.70	$511.50