Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $425.22 / $501.83 / $1,037.32	Professional		$425.22	$501.83	$1,037.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $49.12 / $88.04	Professional	26	$42.70	$49.12	$88.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $382.51 / $452.70 / $949.29	Professional	TC	$382.51	$452.70	$949.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $376.75 / $976.41 / $1,528.86	Professional		$376.75	$976.41	$1,528.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.87 / $98.41 / $145.32	Professional	26	$41.87	$98.41	$145.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $334.88 / $878.02 / $1,383.54	Professional	TC	$334.88	$878.02	$1,383.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $480.56 / $753.69 / $1,005.62	Professional		$480.56	$753.69	$1,005.62
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.74 / $92.73 / $179.15	Professional	26	$52.74	$92.73	$179.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $427.82 / $778.59 / $902.59	Professional	TC	$427.82	$778.59	$902.59
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $255.86 / $255.86 / $255.86	Facility	26	$255.86	$255.86	$255.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $537.86 / $942.94 / $3,946.60	Professional		$537.86	$942.94	$3,946.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $56.54 / $60.27 / $363.38	Professional	26	$56.54	$60.27	$363.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $396.38 / $529.07 / $3,586.83	Professional	TC	$396.38	$529.07	$3,586.83
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $139.09 / $139.09 / $139.09	Facility	26	$139.09	$139.09	$139.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,011.05 / $1,439.75	Professional		$645.65	$1,011.05	$1,439.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.03 / $511.69 / $924.19	Professional		$56.03	$511.69	$924.19
United Facility/Professional Professional Modifier Low / Median / High Price $537.86 / $554.00 / $1,259.13	Professional		$537.86	$554.00	$1,259.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.27 / $60.09 / $180.73	Professional	26	$58.27	$60.09	$180.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $479.52 / $493.91 / $1,122.56	Professional	TC	$479.52	$493.91	$1,122.56
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $951.50 / $1,119.40 / $1,316.40	Professional		$951.50	$1,119.40	$1,316.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $95.90 / $112.80 / $132.69	Professional	26	$95.90	$112.80	$132.69
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $855.60 / $1,006.60 / $1,183.80	Professional	TC	$855.60	$1,006.60	$1,183.80