Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $215.17 / $215.17 / $591.01	Facility	26	$215.17	$215.17	$591.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.14 / $249.67 / $380.51	Professional		$213.14	$249.67	$380.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $113.25 / $187.22	Professional	26	$55.00	$113.25	$187.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.89 / $124.34 / $220.00	Professional	TC	$99.89	$124.34	$220.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $349.35 / $359.83 / $370.31	Facility	26	$349.35	$359.83	$370.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $432.67 / $980.48 / $1,225.60	Professional		$432.67	$980.48	$1,225.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.35 / $258.31 / $353.97	Professional	26	$119.35	$258.31	$353.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.12 / $636.09 / $902.72	Professional	TC	$234.12	$636.09	$902.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $364.33 / $542.79 / $1,123.56	Professional		$364.33	$542.79	$1,123.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.15 / $153.15 / $253.69	Professional	26	$106.15	$153.15	$253.69
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $258.18 / $392.91 / $693.60	Professional	TC	$258.18	$392.91	$693.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $830.40 / $1,061.59 / $1,061.59	Facility	26	$830.40	$1,061.59	$1,061.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $432.67 / $580.41 / $1,915.39	Professional		$432.67	$580.41	$1,915.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $116.57 / $152.91 / $717.76	Professional	26	$116.57	$152.91	$717.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $323.58 / $432.84 / $1,435.54	Professional	TC	$323.58	$432.84	$1,435.54
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $359.83 / $370.31 / $630.00	Facility	26	$359.83	$370.31	$630.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.00 / $476.08 / $960.04	Professional		$398.00	$476.08	$960.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $293.50 / $293.50 / $1,511.10	Professional		$293.50	$293.50	$1,511.10
United Facility/Professional Professional Modifier Low / Median / High Price $445.72 / $578.50 / $1,019.57	Professional		$445.72	$578.50	$1,019.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $117.43 / $145.05 / $267.74	Professional	26	$117.43	$145.05	$267.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $328.29 / $426.78 / $777.14	Professional	TC	$328.29	$426.78	$777.14
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $633.74 / $802.20 / $943.80	Professional		$633.74	$802.20	$943.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $172.38 / $218.20 / $256.70	Professional	26	$172.38	$218.20	$256.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $461.36 / $584.00 / $687.00	Professional	TC	$461.36	$584.00	$687.00