Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,218.00 / $3,259.25 / $7,119.04	Facility		$2,218.00	$3,259.25	$7,119.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.30 / $521.33 / $1,074.77	Professional		$370.30	$521.33	$1,074.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $122.12 / $146.19 / $349.94	Professional	26	$122.12	$146.19	$349.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $237.40 / $317.33 / $724.83	Professional	TC	$237.40	$317.33	$724.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $783.11 / $915.25 / $1,045.94	Professional		$783.11	$915.25	$1,045.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $271.45 / $331.47 / $391.98	Professional	26	$271.45	$331.47	$391.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $511.65 / $606.67 / $708.59	Professional	TC	$511.65	$606.67	$708.59
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $315.58 / $493.91 / $826.97	Professional		$315.58	$493.91	$826.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $116.12 / $182.15 / $307.33	Professional	26	$116.12	$182.15	$307.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.46 / $311.76 / $385.81	Professional	TC	$199.46	$311.76	$385.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $384.65 / $871.13 / $3,482.00	Facility		$384.65	$871.13	$3,482.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $564.64 / $564.64 / $564.64	Facility	26	$564.64	$564.64	$564.64
Medica Facility/Professional Professional Modifier Low / Median / High Price $420.69 / $854.22 / $1,281.78	Professional		$420.69	$854.22	$1,281.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $148.65 / $299.77 / $930.32	Professional	26	$148.65	$299.77	$930.32
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $257.95 / $534.67 / $1,914.08	Professional	TC	$257.95	$534.67	$1,914.08
Midlands Facility/Professional Facility Modifier Low / Median / High Price $364.55 / $551.36 / $1,040.06	Facility		$364.55	$551.36	$1,040.06
Midlands Facility/Professional Professional Modifier Low / Median / High Price $516.72 / $783.11 / $1,058.25	Professional		$516.72	$783.11	$1,058.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $641.79 / $1,058.90	Professional		$3.00	$641.79	$1,058.90
United Facility/Professional Facility Modifier Low / Median / High Price $1,775.00 / $3,522.00 / $5,454.00	Facility		$1,775.00	$3,522.00	$5,454.00
United Facility/Professional Professional Modifier Low / Median / High Price $402.30 / $727.14 / $1,149.06	Professional		$402.30	$727.14	$1,149.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $142.44 / $262.89 / $403.24	Professional	26	$142.44	$262.89	$403.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $252.02 / $471.97 / $745.82	Professional	TC	$252.02	$471.97	$745.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $690.50 / $690.50 / $812.40	Professional		$690.50	$690.50	$812.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.40 / $239.40 / $281.60	Professional	26	$239.40	$239.40	$281.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $451.20 / $451.20 / $530.79	Professional	TC	$451.20	$451.20	$530.79