Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $549.54 / $758.58	Facility	26	$257.04	$549.54	$758.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,380.38 / $3,981.07	Professional		$954.99	$1,380.38	$3,981.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $478.63 / $1,479.11	Professional	26	$263.03	$478.63	$1,479.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $1,000.00 / $2,754.23	Professional	TC	$691.83	$1,000.00	$2,754.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,454.71 / $2,630.27	Professional		$2,137.96	$2,454.71	$2,630.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $562.34 / $676.08 / $707.95	Professional	26	$562.34	$676.08	$707.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,548.82 / $1,778.28 / $1,949.84	Professional	TC	$1,548.82	$1,778.28	$1,949.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,318.26 / $3,801.89	Professional		$870.96	$1,318.26	$3,801.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $416.87 / $1,698.24	Professional	26	$269.15	$416.87	$1,698.24
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $691.83 / $933.25 / $2,344.23	Professional	TC	$691.83	$933.25	$2,344.23
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $2,630.27 / $2,630.27 / $2,630.27	Facility	26	$2,630.27	$2,630.27	$2,630.27
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,949.84 / $3,801.89	Professional		$1,202.26	$1,949.84	$3,801.89
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $489.78 / $1,778.28	Professional	26	$323.59	$489.78	$1,778.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $812.83 / $1,071.52 / $5,128.61	Professional	TC	$812.83	$1,071.52	$5,128.61
Midlands Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $2,454.71 / $3,890.45	Professional		$2,290.87	$2,454.71	$3,890.45
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $691.83 / $1,174.90	Professional	26	$660.69	$691.83	$1,174.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,621.81 / $1,778.28 / $2,691.53	Professional	TC	$1,621.81	$1,778.28	$2,691.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,818.38	Professional		$2,137.96	$2,137.96	$2,818.38
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $602.56 / $602.56 / $776.25	Professional	26	$602.56	$602.56	$776.25
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,513.56 / $1,513.56 / $2,041.74	Professional	TC	$1,513.56	$1,513.56	$2,041.74
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $954.99 / $2,041.74	Professional		$338.84	$954.99	$2,041.74
United Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,548.82 / $3,090.30	Professional		$1,148.15	$1,548.82	$3,090.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $489.78 / $870.96	Professional	26	$323.59	$489.78	$870.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $812.83 / $1,071.52 / $2,187.76	Professional	TC	$812.83	$1,071.52	$2,187.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,995.26 / $2,344.23	Professional		$1,584.89	$1,995.26	$2,344.23
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $457.09 / $575.44 / $676.08	Professional	26	$457.09	$575.44	$676.08
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,122.02 / $1,412.54 / $1,659.59	Professional	TC	$1,122.02	$1,412.54	$1,659.59