Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.46 / $211.54 / $583.77	Facility	26	$103.46	$211.54	$583.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $388.26 / $606.73	Professional		$275.00	$388.26	$606.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $116.10 / $567.44	Professional	26	$55.00	$116.10	$567.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $168.65 / $220.00 / $380.16	Professional	TC	$168.65	$220.00	$380.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $355.35 / $366.01 / $376.67	Facility	26	$355.35	$366.01	$376.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $508.32 / $980.48 / $1,260.11	Professional		$508.32	$980.48	$1,260.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $119.14 / $253.65 / $352.79	Professional	26	$119.14	$253.65	$352.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $343.30 / $726.83 / $966.80	Professional	TC	$343.30	$726.83	$966.80
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $364.63 / $627.29 / $1,387.71	Professional		$364.63	$627.29	$1,387.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.45 / $170.73 / $439.72	Professional	26	$104.45	$170.73	$439.72
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $260.18 / $457.10 / $952.42	Professional	TC	$260.18	$457.10	$952.42
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $815.92 / $1,048.24 / $1,048.24	Facility	26	$815.92	$1,048.24	$1,048.24
Medica Facility/Professional Professional Modifier Low / Median / High Price $455.90 / $679.70 / $4,801.00	Professional		$455.90	$679.70	$4,801.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $120.90 / $162.11 / $1,632.94	Professional	26	$120.90	$162.11	$1,632.94
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $328.53 / $461.80 / $3,601.00	Professional	TC	$328.53	$461.80	$3,601.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $366.01 / $376.67 / $621.60	Facility	26	$366.01	$376.67	$621.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $543.10 / $744.87 / $1,150.68	Professional		$543.10	$744.87	$1,150.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $113.46 / $378.46 / $699.42	Professional		$113.46	$378.46	$699.42
United Facility/Professional Professional Modifier Low / Median / High Price $441.79 / $540.91 / $944.95	Professional		$441.79	$540.91	$944.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $116.04 / $145.08 / $262.77	Professional	26	$116.04	$145.08	$262.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $325.75 / $388.92 / $720.76	Professional	TC	$325.75	$388.92	$720.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $634.21 / $802.80 / $944.50	Professional		$634.21	$802.80	$944.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $169.30 / $214.30 / $252.20	Professional	26	$169.30	$214.30	$252.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $464.92 / $588.50 / $692.30	Professional	TC	$464.92	$588.50	$692.30