Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.04 / $244.62 / $629.77	Facility	26	$113.04	$244.62	$629.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $376.07 / $475.00 / $1,120.60	Professional		$376.07	$475.00	$1,120.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.98 / $140.00 / $531.00	Professional	26	$119.98	$140.00	$531.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $249.04 / $335.00 / $515.29	Professional	TC	$249.04	$335.00	$515.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $388.41 / $400.06 / $411.71	Facility	26	$388.41	$400.06	$411.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $469.80 / $897.14 / $1,402.50	Professional		$469.80	$897.14	$1,402.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.43 / $277.70 / $386.23	Professional	26	$129.43	$277.70	$386.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $365.35 / $616.91 / $1,082.14	Professional	TC	$365.35	$616.91	$1,082.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $321.70 / $480.82 / $2,191.44	Professional		$321.70	$480.82	$2,191.44
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.74 / $166.01 / $786.83	Professional	26	$113.74	$166.01	$786.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $207.97 / $325.04 / $1,385.56	Professional	TC	$207.97	$325.04	$1,385.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $888.48 / $1,142.00 / $1,142.00	Facility	26	$888.48	$1,142.00	$1,142.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $472.46 / $757.72 / $3,919.13	Professional		$472.46	$757.72	$3,919.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $130.28 / $187.98 / $771.93	Professional	26	$130.28	$187.98	$771.93
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $308.66 / $487.23 / $3,292.02	Professional	TC	$308.66	$487.23	$3,292.02
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $400.06 / $411.71 / $679.50	Facility	26	$400.06	$411.71	$679.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $702.15 / $864.92 / $1,291.38	Professional		$702.15	$864.92	$1,291.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $122.97 / $343.95 / $613.95	Professional		$122.97	$343.95	$613.95
United Facility/Professional Professional Modifier Low / Median / High Price $433.09 / $645.70 / $1,222.47	Professional		$433.09	$645.70	$1,222.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $127.84 / $187.98 / $383.36	Professional	26	$127.84	$187.98	$383.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $295.24 / $414.82 / $839.11	Professional	TC	$295.24	$414.82	$839.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $645.11 / $816.60 / $960.80	Professional		$645.11	$816.60	$960.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $214.09 / $271.00 / $318.80	Professional	26	$214.09	$271.00	$318.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $431.10 / $545.70 / $642.00	Professional	TC	$431.10	$545.70	$642.00