Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $143.27 / $272.85 / $504.08	Facility	26	$143.27	$272.85	$504.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.15 / $475.00 / $825.89	Professional		$346.15	$475.00	$825.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.00 / $128.00 / $199.08	Professional	26	$85.00	$128.00	$199.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $259.33 / $335.00 / $488.08	Professional	TC	$259.33	$335.00	$488.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $265.86 / $273.83 / $281.81	Facility	26	$265.86	$273.83	$281.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $439.90 / $819.72 / $1,309.95	Professional		$439.90	$819.72	$1,309.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $90.22 / $192.37 / $262.62	Professional	26	$90.22	$192.37	$262.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $368.23 / $625.44 / $1,090.67	Professional	TC	$368.23	$625.44	$1,090.67
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $299.51 / $556.00 / $1,535.14	Professional		$299.51	$556.00	$1,535.14
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.05 / $129.02 / $371.20	Professional	26	$79.05	$129.02	$371.20
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.47 / $414.27 / $1,163.94	Professional	TC	$220.47	$414.27	$1,163.94
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $618.08 / $789.92 / $789.92	Facility	26	$618.08	$789.92	$789.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $395.37 / $678.04 / $3,014.38	Professional		$395.37	$678.04	$3,014.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $86.96 / $113.24 / $597.70	Professional	26	$86.96	$113.24	$597.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $293.42 / $421.37 / $2,544.17	Professional	TC	$293.42	$421.37	$2,544.17
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $273.83 / $281.81 / $468.90	Facility	26	$273.83	$281.81	$468.90
Midlands Facility/Professional Professional Modifier Low / Median / High Price $649.85 / $819.72 / $1,166.09	Professional		$649.85	$819.72	$1,166.09
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.01 / $314.72 / $588.99	Professional		$86.01	$314.72	$588.99
United Facility/Professional Professional Modifier Low / Median / High Price $364.55 / $468.05 / $934.42	Professional		$364.55	$468.05	$934.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.96 / $104.36 / $221.82	Professional	26	$86.96	$104.36	$221.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $272.47 / $361.18 / $1,347.27	Professional	TC	$272.47	$361.18	$1,347.27
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $605.77 / $766.80 / $902.10	Professional		$605.77	$766.80	$902.10
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 $456.94 / $578.40 / $680.50	Professional	TC	$456.94	$578.40	$680.50