Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $141.25 / $537.03	Facility	26	$141.25	$141.25	$537.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,000.00 / $6,025.60	Professional		$741.31	$1,000.00	$6,025.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $891.25 / $5,495.41	Professional	TC	$602.56	$891.25	$5,495.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $371.54 / $380.19	Facility	26	$354.81	$371.54	$380.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $2,290.87 / $2,818.38	Professional		$1,737.80	$2,290.87	$2,818.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,479.11 / $2,041.74 / $2,570.40	Professional	TC	$1,479.11	$2,041.74	$2,570.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $1,148.15 / $2,454.71	Professional		$426.58	$1,148.15	$2,454.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $162.18 / $281.84	Professional	26	$97.72	$162.18	$281.84
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $1,023.29 / $2,238.72	Professional	TC	$416.87	$1,023.29	$2,238.72
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $371.54 / $371.54 / $446.68	Facility	26	$371.54	$371.54	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $1,174.90 / $3,162.28	Professional		$446.68	$1,174.90	$3,162.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $870.96 / $5,754.40	Professional	TC	$457.09	$870.96	$5,754.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,819.70 / $2,570.40	Professional		$954.99	$1,819.70	$2,570.40
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $223.87 / $380.19	Professional	26	$194.98	$223.87	$380.19
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $1,621.81 / $2,344.23	Professional	TC	$562.34	$1,621.81	$2,344.23
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Facility	26	$380.19	$380.19	$380.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,187.76 / $2,570.40	Professional		$2,187.76	$2,187.76	$2,570.40
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,995.26 / $1,995.26 / $2,344.23	Professional	TC	$1,995.26	$1,995.26	$2,344.23
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $954.99 / $1,905.46	Professional		$114.82	$954.99	$1,905.46
United Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $977.24 / $1,778.28	Professional		$575.44	$977.24	$1,778.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $851.14 / $1,412.54	Professional	TC	$457.09	$851.14	$1,412.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,737.80 / $2,041.74	Professional		$1,380.38	$1,737.80	$2,041.74
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,548.82 / $1,819.70	Professional	TC	$1,230.27	$1,548.82	$1,819.70