Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $210.68 / $638.57 / $1,070.86	Facility	26	$210.68	$638.57	$1,070.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $449.31 / $697.15 / $2,751.00	Professional		$449.31	$697.15	$2,751.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $216.01 / $469.88 / $1,230.00	Professional	26	$216.01	$469.88	$1,230.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $233.30 / $381.89 / $1,800.47	Professional	TC	$233.30	$381.89	$1,800.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $716.70 / $738.20 / $759.70	Facility	26	$716.70	$738.20	$759.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $946.20 / $1,137.95 / $1,422.44	Professional		$946.20	$1,137.95	$1,422.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $451.66 / $523.60 / $654.50	Professional	26	$451.66	$523.60	$654.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $494.54 / $614.35 / $767.94	Professional	TC	$494.54	$614.35	$767.94
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $431.24 / $795.33 / $3,161.78	Professional		$431.24	$795.33	$3,161.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $210.45 / $342.90 / $1,164.03	Professional	26	$210.45	$342.90	$1,164.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $220.78 / $414.00 / $1,842.60	Professional	TC	$220.78	$414.00	$1,842.60
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $738.20 / $738.20 / $738.20	Facility	26	$738.20	$738.20	$738.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $508.71 / $912.51 / $4,584.85	Professional		$508.71	$912.51	$4,584.85
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $244.85 / $297.58 / $1,699.00	Professional	26	$244.85	$297.58	$1,699.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $263.86 / $359.80 / $6,233.93	Professional	TC	$263.86	$359.80	$6,233.93
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $738.20 / $759.70 / $1,255.32	Facility	26	$738.20	$759.70	$1,255.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $905.62 / $1,079.82 / $1,947.00	Professional		$905.62	$1,079.82	$1,947.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $227.96 / $423.35 / $806.12	Professional		$227.96	$423.35	$806.12
United Facility/Professional Professional Modifier Low / Median / High Price $508.71 / $616.87 / $1,001.96	Professional		$508.71	$616.87	$1,001.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $244.85 / $289.86 / $429.60	Professional	26	$244.85	$289.86	$429.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.86 / $340.11 / $1,193.04	Professional	TC	$263.86	$340.11	$1,193.04
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $710.29 / $899.10 / $1,057.80	Professional		$710.29	$899.10	$1,057.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $331.56 / $419.70 / $493.70	Professional	26	$331.56	$419.70	$493.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $378.73 / $479.40 / $564.10	Professional	TC	$378.73	$479.40	$564.10