Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $156.88 / $264.98 / $489.51	Facility	26	$156.88	$264.98	$489.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $276.55 / $425.00 / $666.86	Professional		$276.55	$425.00	$666.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.44 / $124.32 / $177.65	Professional	26	$82.44	$124.32	$177.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $192.05 / $299.00 / $368.50	Professional	TC	$192.05	$299.00	$368.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $257.10 / $264.81 / $272.52	Facility	26	$257.10	$264.81	$272.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $401.30 / $661.34 / $1,342.70	Professional		$401.30	$661.34	$1,342.70
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.38 / $185.39 / $255.94	Professional	26	$86.38	$185.39	$255.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $300.39 / $469.75 / $1,130.54	Professional	TC	$300.39	$469.75	$1,130.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $238.78 / $442.60 / $1,607.67	Professional		$238.78	$442.60	$1,607.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.91 / $123.14 / $417.76	Professional	26	$75.91	$123.14	$417.76
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $162.87 / $306.02 / $1,374.08	Professional	TC	$162.87	$306.02	$1,374.08
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $593.12 / $764.32 / $764.32	Facility	26	$593.12	$764.32	$764.32
Medica Facility/Professional Professional Modifier Low / Median / High Price $347.98 / $579.96 / $3,389.77	Professional		$347.98	$579.96	$3,389.77
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.92 / $144.10 / $657.14	Professional	26	$87.92	$144.10	$657.14
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $246.26 / $410.44 / $2,953.83	Professional	TC	$246.26	$410.44	$2,953.83
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $264.81 / $272.52 / $453.36	Facility	26	$264.81	$272.52	$453.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $523.11 / $716.29 / $1,053.00	Professional		$523.11	$716.29	$1,053.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.75 / $272.99 / $467.68	Professional		$82.75	$272.99	$467.68
United Facility/Professional Professional Modifier Low / Median / High Price $320.95 / $507.47 / $1,726.20	Professional		$320.95	$507.47	$1,726.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.30 / $127.14 / $252.43	Professional	26	$87.30	$127.14	$252.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.74 / $351.11 / $642.08	Professional	TC	$225.74	$351.11	$642.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $480.48 / $608.20 / $715.50	Professional		$480.48	$608.20	$715.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $142.91 / $180.90 / $212.80	Professional	26	$142.91	$180.90	$212.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $337.57 / $427.30 / $502.70	Professional	TC	$337.57	$427.30	$502.70