Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $186.73 / $450.78 / $833.68	Facility	26	$186.73	$450.78	$833.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $317.47 / $660.27 / $1,961.00	Professional		$317.47	$660.27	$1,961.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.81 / $226.80 / $872.89	Professional	26	$131.81	$226.80	$872.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $185.65 / $433.47 / $1,500.65	Professional	TC	$185.65	$433.47	$1,500.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $477.53 / $491.86 / $506.18	Facility	26	$477.53	$491.86	$506.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $863.51 / $1,089.08 / $1,361.35	Professional		$863.51	$1,089.08	$1,361.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $304.79 / $353.72 / $442.15	Professional	26	$304.79	$353.72	$442.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $509.60 / $735.36 / $919.20	Professional	TC	$509.60	$735.36	$919.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $457.77 / $633.12 / $1,782.12	Professional		$457.77	$633.12	$1,782.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $157.27 / $219.33 / $635.99	Professional	26	$157.27	$219.33	$635.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $304.18 / $419.38 / $801.69	Professional	TC	$304.18	$419.38	$801.69
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $491.86 / $491.86 / $491.86	Facility	26	$491.86	$491.86	$491.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $421.46 / $577.73 / $1,447.98	Professional		$421.46	$577.73	$1,447.98
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $165.24 / $195.60 / $768.57	Professional	26	$165.24	$195.60	$768.57
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $232.07 / $305.94 / $1,033.27	Professional	TC	$232.07	$305.94	$1,033.27
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $491.86 / $506.18 / $847.14	Facility	26	$491.86	$506.18	$847.14
Midlands Facility/Professional Professional Modifier Low / Median / High Price $640.41 / $897.79 / $1,279.85	Professional		$640.41	$897.79	$1,279.85
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $154.57 / $407.54 / $764.57	Professional		$154.57	$407.54	$764.57
United Facility/Professional Professional Modifier Low / Median / High Price $421.46 / $489.00 / $764.46	Professional		$421.46	$489.00	$764.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $165.24 / $192.27 / $289.91	Professional	26	$165.24	$192.27	$289.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.94 / $305.94 / $453.43	Professional	TC	$234.94	$305.94	$453.43
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $677.66 / $857.80 / $1,009.20	Professional		$677.66	$857.80	$1,009.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $224.44 / $284.10 / $334.20	Professional	26	$224.44	$284.10	$334.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $453.22 / $573.70 / $675.00	Professional	TC	$453.22	$573.70	$675.00