Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $555.79 / $555.79 / $555.79	Facility		$555.79	$555.79	$555.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.43 / $94.07 / $357.86	Professional		$34.43	$94.07	$357.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $54.62 / $134.61	Professional	26	$19.50	$54.62	$134.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.17 / $39.45 / $163.52	Professional	TC	$27.17	$39.45	$163.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $137.11 / $170.75 / $405.02	Professional		$137.11	$170.75	$405.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.70 / $94.52 / $144.94	Professional	26	$65.70	$94.52	$144.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.17 / $72.09 / $238.00	Professional	TC	$60.17	$72.09	$238.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $57.53 / $104.58 / $510.08	Professional		$57.53	$104.58	$510.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $63.71 / $296.64	Professional	26	$33.97	$63.71	$296.64
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.56 / $44.09 / $351.14	Professional	TC	$23.56	$44.09	$351.14
Medica Facility/Professional Facility Modifier Low / Median / High Price $70.23 / $241.24 / $528.34	Facility		$70.23	$241.24	$528.34
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.66 / $196.78 / $1,317.18	Professional		$81.66	$196.78	$1,317.18
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.56 / $106.92 / $638.00	Professional	26	$44.56	$106.92	$638.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.00 / $86.82 / $870.88	Professional	TC	$32.00	$86.82	$870.88
Midlands Facility/Professional Facility Modifier Low / Median / High Price $46.41 / $139.75 / $198.13	Facility		$46.41	$139.75	$198.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $105.77 / $159.29 / $379.88	Professional		$105.77	$159.29	$379.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $83.80 / $554.29	Professional		$3.00	$83.80	$554.29
United Facility/Professional Facility Modifier Low / Median / High Price $1,204.00 / $1,640.00 / $2,126.00	Facility		$1,204.00	$1,640.00	$2,126.00
United Facility/Professional Professional Modifier Low / Median / High Price $73.37 / $154.38 / $297.82	Professional		$73.37	$154.38	$297.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $89.85 / $235.85	Professional	26	$42.70	$89.85	$235.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.67 / $64.54 / $231.09	Professional	TC	$30.67	$64.54	$231.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $97.33 / $123.20 / $145.00	Professional		$97.33	$123.20	$145.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $55.30 / $70.00 / $82.30	Professional	26	$55.30	$70.00	$82.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $42.11 / $53.30 / $62.70	Professional	TC	$42.11	$53.30	$62.70