Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $142.00 / $272.85 / $504.08	Facility	26	$142.00	$272.85	$504.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $345.50 / $475.00 / $1,053.06	Professional		$345.50	$475.00	$1,053.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.81 / $128.00 / $322.00	Professional	26	$84.81	$128.00	$322.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $258.58 / $335.00 / $523.44	Professional	TC	$258.58	$335.00	$523.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $266.95 / $274.97 / $282.98	Facility	26	$266.95	$274.97	$282.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $439.33 / $821.26 / $1,308.52	Professional		$439.33	$821.26	$1,308.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.89 / $191.60 / $263.60	Professional	26	$89.89	$191.60	$263.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $367.66 / $626.98 / $1,089.25	Professional	TC	$367.66	$626.98	$1,089.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $298.10 / $553.34 / $1,513.16	Professional		$298.10	$553.34	$1,513.16
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.77 / $128.51 / $340.99	Professional	26	$78.77	$128.51	$340.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $219.33 / $412.14 / $1,160.11	Professional	TC	$219.33	$412.14	$1,160.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $615.67 / $789.92 / $789.92	Facility	26	$615.67	$789.92	$789.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $397.18 / $675.45 / $3,007.15	Professional		$397.18	$675.45	$3,007.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $87.29 / $113.67 / $848.54	Professional	26	$87.29	$113.67	$848.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $294.45 / $423.40 / $2,544.17	Professional	TC	$294.45	$423.40	$2,544.17
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $274.97 / $282.98 / $468.90	Facility	26	$274.97	$282.98	$468.90
Midlands Facility/Professional Professional Modifier Low / Median / High Price $647.38 / $821.26 / $1,160.43	Professional		$647.38	$821.26	$1,160.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $84.68 / $305.70 / $562.01	Professional		$84.68	$305.70	$562.01
United Facility/Professional Professional Modifier Low / Median / High Price $361.07 / $470.19 / $937.76	Professional		$361.07	$470.19	$937.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.29 / $104.75 / $222.64	Professional	26	$87.29	$104.75	$222.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $273.77 / $362.92 / $715.12	Professional	TC	$273.77	$362.92	$715.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $602.77 / $763.00 / $897.70	Professional		$602.77	$763.00	$897.70
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $148.19 / $187.60 / $220.70	Professional	26	$148.19	$187.60	$220.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $454.57 / $575.40 / $677.00	Professional	TC	$454.57	$575.40	$677.00