Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $253.81 / $728.32 / $728.32	Facility	26	$253.81	$728.32	$728.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,068.84 / $1,322.69 / $2,646.60	Professional		$1,068.84	$1,322.69	$2,646.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $263.93 / $388.02 / $1,464.00	Professional	26	$263.93	$388.02	$1,464.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $779.44 / $981.11 / $1,925.74	Professional	TC	$779.44	$981.11	$1,925.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,065.09 / $2,448.63 / $2,797.10	Professional		$2,065.09	$2,448.63	$2,797.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $551.34 / $684.32 / $767.43	Professional	26	$551.34	$684.32	$767.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,513.75 / $1,764.33 / $2,029.68	Professional	TC	$1,513.75	$1,764.33	$2,029.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $868.06 / $1,322.48 / $3,424.21	Professional		$868.06	$1,322.48	$3,424.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $266.89 / $408.84 / $895.89	Professional	26	$266.89	$408.84	$895.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $601.16 / $938.79 / $2,149.56	Professional	TC	$601.16	$938.79	$2,149.56
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $2,654.96 / $2,654.96 / $2,654.96	Facility	26	$2,654.96	$2,654.96	$2,654.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,194.47 / $2,314.25 / $3,804.58	Professional		$1,194.47	$2,314.25	$3,804.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $337.25 / $660.93 / $1,791.90	Professional	26	$337.25	$660.93	$1,791.90
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $857.22 / $1,728.73 / $5,096.49	Professional	TC	$857.22	$1,728.73	$5,096.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,454.82 / $2,295.16 / $2,797.10	Professional		$1,454.82	$2,295.16	$2,797.10
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $318.32 / $1,017.29 / $1,985.28	Professional		$318.32	$1,017.29	$1,985.28
United Facility/Professional Professional Modifier Low / Median / High Price $1,144.70 / $2,050.81 / $2,826.90	Professional		$1,144.70	$2,050.81	$2,826.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $323.20 / $600.62 / $1,358.49	Professional	26	$323.20	$600.62	$1,358.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $821.50 / $1,550.14 / $2,028.75	Professional	TC	$821.50	$1,550.14	$2,028.75
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,569.26 / $1,986.40 / $2,336.90	Professional		$1,569.26	$1,986.40	$2,336.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $452.28 / $572.50 / $673.50	Professional	26	$452.28	$572.50	$673.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,116.98 / $1,413.90 / $1,663.40	Professional	TC	$1,116.98	$1,413.90	$1,663.40