Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $137.75 / $274.98 / $508.01	Facility	26	$137.75	$274.98	$508.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $252.89 / $297.62 / $513.26	Professional		$252.89	$297.62	$513.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $84.84 / $140.21	Professional	26	$55.00	$84.84	$140.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.49 / $220.00 / $380.41	Professional	TC	$168.49	$220.00	$380.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $271.94 / $280.10 / $288.26	Facility	26	$271.94	$280.10	$288.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $386.97 / $726.06 / $1,153.32	Professional		$386.97	$726.06	$1,153.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.25 / $192.37 / $264.69	Professional	26	$90.25	$192.37	$264.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $314.07 / $533.67 / $929.78	Professional	TC	$314.07	$533.67	$929.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $270.32 / $465.00 / $1,361.80	Professional		$270.32	$465.00	$1,361.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.09 / $129.26 / $342.92	Professional	26	$79.09	$129.26	$342.92
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.23 / $336.00 / $1,116.08	Professional	TC	$191.23	$336.00	$1,116.08
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $618.08 / $792.40 / $792.40	Facility	26	$618.08	$792.40	$792.40
Medica Facility/Professional Professional Modifier Low / Median / High Price $331.52 / $571.42 / $3,081.89	Professional		$331.52	$571.42	$3,081.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $89.41 / $114.14 / $554.78	Professional	26	$89.41	$114.14	$554.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $235.10 / $365.86 / $2,625.91	Professional	TC	$235.10	$365.86	$2,625.91
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $280.10 / $288.26 / $469.68	Facility	26	$280.10	$288.26	$469.68
Midlands Facility/Professional Professional Modifier Low / Median / High Price $490.73 / $625.00 / $912.51	Professional		$490.73	$625.00	$912.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $223.85 / $506.42	Professional		$85.01	$223.85	$506.42
United Facility/Professional Professional Modifier Low / Median / High Price $327.69 / $421.93 / $1,441.36	Professional		$327.69	$421.93	$1,441.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.65 / $105.18 / $199.85	Professional	26	$87.65	$105.18	$199.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $224.42 / $278.32 / $487.30	Professional	TC	$224.42	$278.32	$487.30
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $469.97 / $594.90 / $699.90	Professional		$469.97	$594.90	$699.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $128.30 / $162.40 / $191.00	Professional	26	$128.30	$162.40	$191.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $341.68 / $432.50 / $508.90	Professional	TC	$341.68	$432.50	$508.90