Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.68 / $129.10 / $388.41	Facility	26	$69.68	$129.10	$388.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $378.65 / $604.52 / $2,798.00	Professional		$378.65	$604.52	$2,798.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.97 / $85.54 / $456.00	Professional	26	$67.97	$85.54	$456.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $310.70 / $436.19 / $1,090.56	Professional	TC	$310.70	$436.19	$1,090.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $235.77 / $242.84 / $249.92	Facility	26	$235.77	$242.84	$249.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $899.49 / $995.22 / $1,244.03	Professional		$899.49	$995.22	$1,244.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $158.69 / $171.43 / $214.29	Professional	26	$158.69	$171.43	$214.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $740.81 / $823.79 / $1,029.74	Professional	TC	$740.81	$823.79	$1,029.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $365.16 / $547.67 / $1,635.35	Professional		$365.16	$547.67	$1,635.35
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.76 / $100.66 / $291.18	Professional	26	$69.76	$100.66	$291.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $295.39 / $462.24 / $1,344.17	Professional	TC	$295.39	$462.24	$1,344.17
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $242.84 / $242.84 / $242.84	Facility	26	$242.84	$242.84	$242.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $470.28 / $678.30 / $1,431.01	Professional		$470.28	$678.30	$1,431.01
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $77.70 / $101.19 / $381.57	Professional	26	$77.70	$101.19	$381.57
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $364.89 / $475.16 / $1,828.38	Professional	TC	$364.89	$475.16	$1,828.38
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $242.84 / $249.92 / $420.96	Facility	26	$242.84	$249.92	$420.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $630.71 / $944.73 / $1,248.17	Professional		$630.71	$944.73	$1,248.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.56 / $393.73 / $1,424.25	Professional		$74.56	$393.73	$1,424.25
United Facility/Professional Professional Modifier Low / Median / High Price $442.60 / $531.12 / $890.76	Professional		$442.60	$531.12	$890.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.70 / $93.25 / $149.97	Professional	26	$77.70	$93.25	$149.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $364.89 / $437.87 / $743.74	Professional	TC	$364.89	$437.87	$743.74
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $570.14 / $721.70 / $849.00	Professional		$570.14	$721.70	$849.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $100.57 / $127.30 / $149.80	Professional	26	$100.57	$127.30	$149.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $469.58 / $594.40 / $699.20	Professional	TC	$469.58	$594.40	$699.20