Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $346.74 / $660.69	Facility	26	$213.80	$346.74	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $912.01 / $2,754.23	Professional		$416.87	$912.01	$2,754.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $478.63 / $1,202.26	Professional	26	$213.80	$478.63	$1,202.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $501.19 / $1,995.26	Professional	TC	$213.80	$501.19	$1,995.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $724.44 / $741.31 / $758.58	Facility	26	$724.44	$741.31	$758.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,174.90 / $1,445.44	Professional		$1,071.52	$1,174.90	$1,445.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $512.86 / $537.03 / $676.08	Professional	26	$512.86	$537.03	$676.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $630.96 / $794.33	Professional	TC	$575.44	$630.96	$794.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $812.83 / $3,548.13	Professional		$426.58	$812.83	$3,548.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $380.19 / $1,318.26	Professional	26	$234.42	$380.19	$1,318.26
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $446.68 / $2,398.83	Professional	TC	$251.19	$446.68	$2,398.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $741.31 / $741.31 / $1,318.26	Facility	26	$741.31	$741.31	$1,318.26
Medica Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $1,000.00 / $5,370.32	Professional		$537.03	$1,000.00	$5,370.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $302.00 / $1,698.24	Professional	26	$245.47	$302.00	$1,698.24
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $398.11 / $6,165.95	Professional	TC	$263.03	$398.11	$6,165.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,071.52 / $4,677.35	Professional		$954.99	$1,071.52	$4,677.35
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $512.86 / $812.83	Professional	26	$446.68	$512.86	$812.83
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $575.44 / $3,890.45	Professional	TC	$489.78	$575.44	$3,890.45
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $758.58 / $758.58 / $758.58	Facility	26	$758.58	$758.58	$758.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $1,288.25	Professional		$1,148.15	$1,148.15	$1,288.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $537.03 / $602.56	Professional	26	$537.03	$537.03	$602.56
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $676.08	Professional	TC	$602.56	$602.56	$676.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $426.58 / $831.76	Professional		$234.42	$426.58	$831.76
United Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $660.69 / $1,479.11	Professional		$512.86	$660.69	$1,479.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $288.40 / $501.19	Professional	26	$245.47	$288.40	$501.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $338.84 / $1,202.26	Professional	TC	$263.03	$338.84	$1,202.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $891.25 / $1,047.13	Professional		$707.95	$891.25	$1,047.13
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $416.87 / $489.78	Professional	26	$331.13	$416.87	$489.78
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $478.63 / $562.34	Professional	TC	$380.19	$478.63	$562.34