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 $427.44 / $676.35 / $2,779.00	Professional		$427.44	$676.35	$2,779.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $204.35 / $355.23 / $1,342.56	Professional	26	$204.35	$355.23	$1,342.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $219.78 / $340.26 / $1,525.72	Professional	TC	$219.78	$340.26	$1,525.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $670.43 / $690.54 / $710.66	Facility	26	$670.43	$690.54	$710.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $922.39 / $1,111.58 / $1,389.47	Professional		$922.39	$1,111.58	$1,389.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $452.30 / $523.60 / $654.50	Professional	26	$452.30	$523.60	$654.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $470.09 / $587.98 / $734.98	Professional	TC	$470.09	$587.98	$734.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $422.17 / $621.44 / $1,555.48	Professional		$422.17	$621.44	$1,555.48
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $210.45 / $297.18 / $1,335.62	Professional	26	$210.45	$297.18	$1,335.62
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $211.72 / $298.82 / $596.15	Professional	TC	$211.72	$298.82	$596.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $690.54 / $690.54 / $690.54	Facility	26	$690.54	$690.54	$690.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $507.60 / $719.02 / $1,609.03	Professional		$507.60	$719.02	$1,609.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $244.85 / $297.60 / $1,148.30	Professional	26	$244.85	$297.60	$1,148.30
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $262.75 / $317.87 / $1,272.39	Professional	TC	$262.75	$317.87	$1,272.39
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $690.54 / $710.66 / $1,257.11	Facility	26	$690.54	$710.66	$1,257.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $681.47 / $997.36 / $1,254.05	Professional		$681.47	$997.36	$1,254.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $221.59 / $406.91 / $789.20	Professional		$221.59	$406.91	$789.20
United Facility/Professional Professional Modifier Low / Median / High Price $507.60 / $605.48 / $910.33	Professional		$507.60	$605.48	$910.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $237.72 / $289.86 / $429.60	Professional	26	$237.72	$289.86	$429.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $262.75 / $311.04 / $486.68	Professional	TC	$262.75	$311.04	$486.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $694.73 / $879.40 / $1,034.59	Professional		$694.73	$879.40	$1,034.59
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 $363.16 / $459.70 / $540.90	Professional	TC	$363.16	$459.70	$540.90