Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $602.29 / $1,190.14 / $1,993.12	Facility	26	$602.29	$1,190.14	$1,993.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,709.16 / $3,018.54 / $11,080.00	Professional		$1,709.16	$3,018.54	$11,080.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $387.09 / $660.96 / $2,139.00	Professional	26	$387.09	$660.96	$2,139.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,306.59 / $2,021.38 / $8,751.70	Professional	TC	$1,306.59	$2,021.38	$8,751.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1,254.58 / $1,292.23 / $1,329.87	Facility	26	$1,254.58	$1,292.23	$1,329.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $3,589.23 / $4,364.09 / $5,455.11	Professional		$3,589.23	$4,364.09	$5,455.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $841.80 / $975.83 / $1,219.79	Professional	26	$841.80	$975.83	$1,219.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $2,747.43 / $3,388.26 / $4,235.32	Professional	TC	$2,747.43	$3,388.26	$4,235.32
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,609.29 / $2,363.73 / $5,260.75	Professional		$1,609.29	$2,363.73	$5,260.75
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $392.74 / $648.16 / $1,121.84	Professional	26	$392.74	$648.16	$1,121.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,216.55 / $1,859.22 / $3,608.11	Professional	TC	$1,216.55	$1,859.22	$3,608.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $1,292.23 / $1,292.23 / $1,292.23	Facility	26	$1,292.23	$1,292.23	$1,292.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,963.48 / $2,927.36 / $11,628.82	Professional		$1,963.48	$2,927.36	$11,628.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $455.85 / $554.15 / $2,845.07	Professional	26	$455.85	$554.15	$2,845.07
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $1,440.67 / $1,900.69 / $9,015.64	Professional	TC	$1,440.67	$1,900.69	$9,015.64
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $1,292.23 / $1,329.87 / $2,339.52	Facility	26	$1,292.23	$1,329.87	$2,339.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $2,660.00 / $3,841.17 / $5,050.79	Professional		$2,660.00	$3,841.17	$5,050.79
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $425.85 / $1,531.62 / $3,219.57	Professional		$425.85	$1,531.62	$3,219.57
United Facility/Professional Professional Modifier Low / Median / High Price $1,934.94 / $2,324.40 / $3,582.40	Professional		$1,934.94	$2,324.40	$3,582.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $451.96 / $539.64 / $918.70	Professional	26	$451.96	$539.64	$918.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,498.39 / $1,819.79 / $5,211.78	Professional	TC	$1,498.39	$1,819.79	$5,211.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $2,705.83 / $3,425.10 / $4,029.50	Professional		$2,705.83	$3,425.10	$4,029.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $618.80 / $783.30 / $921.50	Professional	26	$618.80	$783.30	$921.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $2,087.10 / $2,641.90 / $3,108.10	Professional	TC	$2,087.10	$2,641.90	$3,108.10