Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,218.00 / $3,576.15 / $7,119.04	Facility		$2,218.00	$3,576.15	$7,119.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.68 / $281.67 / $672.00	Professional		$152.68	$281.67	$672.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.81 / $58.48 / $280.29	Professional	26	$36.81	$58.48	$280.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.87 / $178.78 / $424.06	Professional	TC	$108.87	$178.78	$424.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $324.64 / $456.57 / $528.05	Professional		$324.64	$456.57	$528.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.56 / $103.83 / $119.73	Professional	26	$75.56	$103.83	$119.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $217.85 / $364.62 / $424.23	Professional	TC	$217.85	$364.62	$424.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $249.95 / $612.10	Professional		$144.54	$249.95	$612.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.45 / $74.23 / $141.31	Professional	26	$36.45	$74.23	$141.31
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.33 / $185.66 / $375.74	Professional	TC	$26.33	$185.66	$375.74
Medica Facility/Professional Facility Modifier Low / Median / High Price $277.00 / $352.16 / $1,775.00	Facility		$277.00	$352.16	$1,775.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $181.86 / $181.86 / $181.86	Facility	26	$181.86	$181.86	$181.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $182.63 / $377.00 / $1,531.99	Professional		$182.63	$377.00	$1,531.99
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $47.11 / $98.06 / $907.84	Professional	26	$47.11	$98.06	$907.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $124.38 / $273.29 / $1,117.24	Professional	TC	$124.38	$273.29	$1,117.24
Midlands Facility/Professional Facility Modifier Low / Median / High Price $169.97 / $351.89 / $528.05	Facility		$169.97	$351.89	$528.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $216.61 / $362.45 / $528.05	Professional		$216.61	$362.45	$528.05
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $210.30 / $253.40 / $541.79	Professional		$210.30	$253.40	$541.79
United Facility/Professional Facility Modifier Low / Median / High Price $1,204.00 / $1,607.00 / $2,126.00	Facility		$1,204.00	$1,607.00	$2,126.00
United Facility/Professional Professional Modifier Low / Median / High Price $175.02 / $323.01 / $495.42	Professional		$175.02	$323.01	$495.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.11 / $80.88 / $129.94	Professional	26	$47.11	$80.88	$129.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.22 / $227.08 / $367.62	Professional	TC	$124.22	$227.08	$367.62
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $319.60 / $319.60 / $376.00	Professional		$319.60	$319.60	$376.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $75.09 / $75.09 / $88.30	Professional	26	$75.09	$75.09	$88.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $244.50 / $244.50 / $287.70	Professional	TC	$244.50	$244.50	$287.70