Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $76.75 / $233.22 / $389.06	Facility	26	$76.75	$233.22	$389.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $481.64 / $680.50 / $2,745.00	Professional		$481.64	$680.50	$2,745.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.64 / $166.98 / $415.00	Professional	26	$76.64	$166.98	$415.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $413.91 / $529.59 / $2,446.57	Professional	TC	$413.91	$529.59	$2,446.57
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $248.06 / $255.50 / $262.94	Facility	26	$248.06	$255.50	$262.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $870.58 / $1,043.32 / $1,304.15	Professional		$870.58	$1,043.32	$1,304.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $164.96 / $190.82 / $238.53	Professional	26	$164.96	$190.82	$238.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $705.59 / $852.49 / $1,065.61	Professional	TC	$705.59	$852.49	$1,065.61
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $381.33 / $535.86 / $1,470.79	Professional		$381.33	$535.86	$1,470.79
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.63 / $124.79 / $396.79	Professional	26	$76.63	$124.79	$396.79
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $304.70 / $431.84 / $1,021.81	Professional	TC	$304.70	$431.84	$1,021.81
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $255.50 / $255.50 / $255.50	Facility	26	$255.50	$255.50	$255.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $493.00 / $697.10 / $1,534.54	Professional		$493.00	$697.10	$1,534.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $89.58 / $107.92 / $1,350.00	Professional	26	$89.58	$107.92	$1,350.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $400.69 / $516.65 / $3,149.00	Professional	TC	$400.69	$516.65	$3,149.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $255.50 / $262.94 / $458.40	Facility	26	$255.50	$262.94	$458.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $601.33 / $967.03 / $1,216.59	Professional		$601.33	$967.03	$1,216.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.99 / $395.80 / $725.80	Professional		$82.99	$395.80	$725.80
United Facility/Professional Professional Modifier Low / Median / High Price $418.52 / $594.85 / $936.69	Professional		$418.52	$594.85	$936.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.84 / $103.18 / $157.18	Professional	26	$87.84	$103.18	$157.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $383.77 / $499.12 / $781.66	Professional	TC	$383.77	$499.12	$781.66
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $643.61 / $814.70 / $958.50	Professional		$643.61	$814.70	$958.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $120.71 / $152.80 / $179.80	Professional	26	$120.71	$152.80	$179.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $522.90 / $661.90 / $778.60	Professional	TC	$522.90	$661.90	$778.60