Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $398.11 / $870.96 / $1,230.27	Facility	26	$398.11	$870.96	$1,230.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,754.23 / $10,715.19	Professional		$1,548.82	$2,754.23	$10,715.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $630.96 / $1,949.84	Professional	26	$389.05	$630.96	$1,949.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,202.26 / $2,187.76 / $8,511.38	Professional	TC	$1,202.26	$2,187.76	$8,511.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1,258.93 / $1,288.25 / $1,318.26	Facility	26	$1,258.93	$1,288.25	$1,318.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,981.07 / $4,466.84 / $5,623.41	Professional		$3,981.07	$4,466.84	$5,623.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $954.99 / $1,000.00 / $1,258.93	Professional	26	$954.99	$1,000.00	$1,258.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3,019.95 / $3,467.37 / $4,365.16	Professional	TC	$3,019.95	$3,467.37	$4,365.16
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $2,511.89 / $6,606.93	Professional		$1,621.81	$2,511.89	$6,606.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $676.08 / $1,584.89	Professional	26	$436.52	$676.08	$1,584.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,380.38 / $2,137.96 / $5,623.41	Professional	TC	$1,380.38	$2,137.96	$5,623.41
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $1,288.25 / $1,288.25 / $1,905.46	Facility	26	$1,288.25	$1,288.25	$1,905.46
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $3,235.94 / $11,748.98	Professional		$1,905.46	$3,235.94	$11,748.98
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $549.54 / $2,818.38	Professional	26	$446.68	$549.54	$2,818.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $1,288.25 / $1,905.46 / $8,912.51	Professional	TC	$1,288.25	$1,905.46	$8,912.51
Midlands Facility/Professional Professional Modifier Low / Median / High Price $3,630.78 / $3,981.07 / $5,370.32	Professional		$3,630.78	$3,981.07	$5,370.32
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $851.14 / $954.99 / $1,445.44	Professional	26	$851.14	$954.99	$1,445.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $2,754.23 / $3,019.95 / $3,890.45	Professional	TC	$2,754.23	$3,019.95	$3,890.45
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Facility	26	$1,318.26	$1,318.26	$1,318.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $4,365.16 / $4,365.16 / $4,897.79	Professional		$4,365.16	$4,365.16	$4,897.79
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $1,000.00 / $1,000.00 / $1,122.02	Professional	26	$1,000.00	$1,000.00	$1,122.02
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $3,388.44 / $3,388.44 / $3,801.89	Professional	TC	$3,388.44	$3,388.44	$3,801.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $1,584.89 / $3,388.44	Professional		$436.52	$1,584.89	$3,388.44
United Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,344.23 / $4,073.80	Professional		$1,819.70	$2,344.23	$4,073.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $537.03 / $933.25	Professional	26	$446.68	$537.03	$933.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,380.38 / $1,819.70 / $3,090.30	Professional	TC	$1,380.38	$1,819.70	$3,090.30
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $3,388.44 / $4,073.80	Professional		$2,691.53	$3,388.44	$4,073.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $616.60 / $776.25 / $912.01	Professional	26	$616.60	$776.25	$912.01
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $2,089.30 / $2,630.27 / $3,090.30	Professional	TC	$2,089.30	$2,630.27	$3,090.30