Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.51 / $217.43 / $560.95	Facility	26	$100.51	$217.43	$560.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $329.24 / $475.00 / $2,011.11	Professional		$329.24	$475.00	$2,011.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.72 / $151.49 / $613.82	Professional	26	$104.72	$151.49	$613.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $217.93 / $335.00 / $557.00	Professional	TC	$217.93	$335.00	$557.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $384.06 / $395.58 / $407.10	Facility	26	$384.06	$395.58	$407.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $527.73 / $883.36 / $1,648.83	Professional		$527.73	$883.36	$1,648.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.85 / $246.67 / $372.19	Professional	26	$115.85	$246.67	$372.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $356.66 / $597.01 / $1,334.15	Professional	TC	$356.66	$597.01	$1,334.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $285.60 / $528.03 / $2,434.77	Professional		$285.60	$528.03	$2,434.77
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.46 / $171.92 / $382.05	Professional	26	$101.46	$171.92	$382.05
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $184.14 / $346.11 / $2,093.21	Professional	TC	$184.14	$346.11	$2,093.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $794.00 / $1,016.96 / $1,016.96	Facility	26	$794.00	$1,016.96	$1,016.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $413.05 / $741.32 / $6,199.75	Professional		$413.05	$741.32	$6,199.75
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $123.37 / $190.66 / $931.20	Professional	26	$123.37	$190.66	$931.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $278.47 / $464.12 / $5,551.18	Professional	TC	$278.47	$464.12	$5,551.18
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $395.58 / $407.10 / $603.00	Facility	26	$395.58	$407.10	$603.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $624.55 / $785.05 / $1,614.00	Professional		$624.55	$785.05	$1,614.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.27 / $300.27 / $535.11	Professional		$109.27	$300.27	$535.11
United Facility/Professional Professional Modifier Low / Median / High Price $378.63 / $522.94 / $1,156.19	Professional		$378.63	$522.94	$1,156.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $121.43 / $168.23 / $341.62	Professional	26	$121.43	$168.23	$341.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $255.26 / $380.58 / $853.22	Professional	TC	$255.26	$380.58	$853.22
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $572.83 / $725.10 / $853.00	Professional		$572.83	$725.10	$853.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $191.10 / $241.90 / $284.60	Professional	26	$191.10	$241.90	$284.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $381.65 / $483.10 / $568.40	Professional	TC	$381.65	$483.10	$568.40