Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.23 / $272.60 / $503.68	Facility	26	$89.23	$272.60	$503.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $277.64 / $425.00 / $669.09	Professional		$277.64	$425.00	$669.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.75 / $126.00 / $182.79	Professional	26	$84.75	$126.00	$182.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $191.40 / $299.00 / $368.50	Professional	TC	$191.40	$299.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $265.55 / $273.52 / $281.48	Facility	26	$265.55	$273.52	$281.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $405.13 / $707.68 / $1,346.97	Professional		$405.13	$707.68	$1,346.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.15 / $192.37 / $267.56	Professional	26	$90.15	$192.37	$267.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $282.77 / $524.07 / $1,127.70	Professional	TC	$282.77	$524.07	$1,127.70
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $240.70 / $445.51 / $1,633.19	Professional		$240.70	$445.51	$1,633.19
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.97 / $129.03 / $444.18	Professional	26	$78.97	$129.03	$444.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $161.72 / $303.88 / $1,391.75	Professional	TC	$161.72	$303.88	$1,391.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $618.08 / $792.16 / $792.16	Facility	26	$618.08	$792.16	$792.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $348.18 / $580.29 / $3,447.72	Professional		$348.18	$580.29	$3,447.72
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $90.47 / $146.10 / $665.40	Professional	26	$90.47	$146.10	$665.40
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $243.52 / $405.86 / $2,996.90	Professional	TC	$243.52	$405.86	$2,996.90
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $273.52 / $281.48 / $469.20	Facility	26	$273.52	$281.48	$469.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $527.02 / $663.93 / $1,070.00	Professional		$527.02	$663.93	$1,070.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.05 / $253.76 / $451.16	Professional		$85.05	$253.76	$451.16
United Facility/Professional Professional Modifier Low / Median / High Price $310.02 / $435.23 / $903.53	Professional		$310.02	$435.23	$903.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.97 / $130.83 / $267.45	Professional	26	$88.97	$130.83	$267.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.22 / $355.12 / $616.72	Professional	TC	$223.22	$355.12	$616.72
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $484.03 / $612.70 / $720.80	Professional		$484.03	$612.70	$720.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $148.76 / $188.30 / $221.60	Professional	26	$148.76	$188.30	$221.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $335.20 / $424.30 / $499.20	Professional	TC	$335.20	$424.30	$499.20