Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.80 / $126.80 / $126.80	Facility	26	$126.80	$126.80	$126.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.74 / $500.49 / $1,328.00	Professional		$293.74	$500.49	$1,328.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $152.55 / $289.83	Professional	26	$89.57	$152.55	$289.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $204.15 / $347.94 / $611.12	Professional	TC	$204.15	$347.94	$611.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $303.81 / $312.92 / $322.04	Facility	26	$303.81	$312.92	$322.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $679.91 / $823.79 / $1,029.74	Professional		$679.91	$823.79	$1,029.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $205.65 / $238.92 / $298.64	Professional	26	$205.65	$238.92	$298.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $474.26 / $584.88 / $731.10	Professional	TC	$474.26	$584.88	$731.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $344.86 / $475.25 / $1,380.07	Professional		$344.86	$475.25	$1,380.07
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.02 / $147.09 / $402.00	Professional	26	$106.02	$147.09	$402.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $241.66 / $332.30 / $698.58	Professional	TC	$241.66	$332.30	$698.58
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $312.92 / $312.92 / $312.92	Facility	26	$312.92	$312.92	$312.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $347.13 / $473.36 / $1,187.58	Professional		$347.13	$473.36	$1,187.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $111.53 / $132.03 / $418.12	Professional	26	$111.53	$132.03	$418.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $235.60 / $279.94 / $1,133.66	Professional	TC	$235.60	$279.94	$1,133.66
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $312.92 / $322.04 / $571.62	Facility	26	$312.92	$322.04	$571.62
Midlands Facility/Professional Professional Modifier Low / Median / High Price $559.30 / $727.60 / $1,136.89	Professional		$559.30	$727.60	$1,136.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $103.65 / $322.82 / $576.23	Professional		$103.65	$322.82	$576.23
United Facility/Professional Professional Modifier Low / Median / High Price $347.13 / $410.94 / $645.79	Professional		$347.13	$410.94	$645.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $111.53 / $132.03 / $214.85	Professional	26	$111.53	$132.03	$214.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $235.60 / $278.91 / $436.54	Professional	TC	$235.60	$278.91	$436.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $510.66 / $646.40 / $760.50	Professional		$510.66	$646.40	$760.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $150.88 / $191.00 / $224.80	Professional	26	$150.88	$191.00	$224.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $359.77 / $455.40 / $535.79	Professional	TC	$359.77	$455.40	$535.79