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 / $562.25	Facility	26	$100.51	$217.43	$562.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $328.59 / $475.00 / $2,046.44	Professional		$328.59	$475.00	$2,046.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.67 / $140.00 / $568.74	Professional	26	$102.67	$140.00	$568.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.18 / $335.00 / $650.69	Professional	TC	$218.18	$335.00	$650.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $351.11 / $361.64 / $372.18	Facility	26	$351.11	$361.64	$372.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $526.65 / $881.56 / $1,623.19	Professional		$526.65	$881.56	$1,623.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.85 / $246.67 / $356.00	Professional	26	$115.85	$246.67	$356.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $355.59 / $595.21 / $1,331.31	Professional	TC	$355.59	$595.21	$1,331.31
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $285.02 / $526.96 / $2,406.46	Professional		$285.02	$526.96	$2,406.46
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.46 / $165.81 / $381.40	Professional	26	$101.46	$165.81	$381.40
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.58 / $345.04 / $2,040.28	Professional	TC	$183.58	$345.04	$2,040.28
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 $412.26 / $727.49 / $6,146.58	Professional		$412.26	$727.49	$6,146.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $117.29 / $190.66 / $921.60	Professional	26	$117.29	$190.66	$921.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $277.31 / $462.80 / $5,551.18	Professional	TC	$277.31	$462.80	$5,551.18
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $361.64 / $372.18 / $603.00	Facility	26	$361.64	$372.18	$603.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $615.88 / $782.08 / $1,598.00	Professional		$615.88	$782.08	$1,598.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.27 / $300.57 / $534.04	Professional		$109.27	$300.57	$534.04
United Facility/Professional Professional Modifier Low / Median / High Price $372.81 / $601.21 / $1,338.81	Professional		$372.81	$601.21	$1,338.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.55 / $164.21 / $341.62	Professional	26	$112.55	$164.21	$341.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $242.97 / $357.72 / $807.47	Professional	TC	$242.97	$357.72	$807.47
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $571.64 / $723.60 / $851.30	Professional		$571.64	$723.60	$851.30
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 $380.46 / $481.60 / $566.60	Professional	TC	$380.46	$481.60	$566.60