Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.79 / $165.79 / $800.96	Facility		$165.79	$165.79	$800.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $398.50 / $398.50 / $398.50	Facility	26	$398.50	$398.50	$398.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $402.45 / $402.45 / $535.16	Facility	TC	$402.45	$402.45	$535.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $362.20 / $421.56 / $882.31	Professional		$362.20	$421.56	$882.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $177.47 / $198.14 / $398.50	Professional	26	$177.47	$198.14	$398.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $184.73 / $206.26 / $502.33	Professional	TC	$184.73	$206.26	$502.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $415.50 / $854.75 / $1,683.00	Professional		$415.50	$854.75	$1,683.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $193.88 / $309.24 / $457.06	Professional	26	$193.88	$309.24	$457.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $221.63 / $443.82 / $1,225.95	Professional	TC	$221.63	$443.82	$1,225.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $284.69 / $332.48 / $943.80	Professional		$284.69	$332.48	$943.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $138.75 / $161.78 / $178.50	Professional	26	$138.75	$161.78	$178.50
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.94 / $170.70 / $189.65	Professional	TC	$145.94	$170.70	$189.65
Medica Facility/Professional Facility Modifier Low / Median / High Price $421.56 / $854.75 / $2,185.65	Facility		$421.56	$854.75	$2,185.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $846.88 / $846.88 / $846.88	Facility	26	$846.88	$846.88	$846.88
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $1,452.72 / $1,452.72 / $1,452.72	Facility	TC	$1,452.72	$1,452.72	$1,452.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $326.06 / $605.20 / $5,718.36	Professional		$326.06	$605.20	$5,718.36
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $179.29 / $185.50 / $1,098.38	Professional	26	$179.29	$185.50	$1,098.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $146.77 / $259.83 / $2,229.25	Professional	TC	$146.77	$259.83	$2,229.25
Midlands Facility/Professional Facility Modifier Low / Median / High Price $451.66 / $569.74 / $971.00	Facility		$451.66	$569.74	$971.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $458.96 / $649.62 / $1,192.78	Professional		$458.96	$649.62	$1,192.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $170.70 / $310.57 / $626.65	Professional		$170.70	$310.57	$626.65
United Facility/Professional Professional Modifier Low / Median / High Price $326.06 / $339.97 / $790.83	Professional		$326.06	$339.97	$790.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $179.29 / $184.67 / $604.41	Professional	26	$179.29	$184.67	$604.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $146.77 / $162.40 / $459.79	Professional	TC	$146.77	$162.40	$459.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $621.79 / $731.60 / $843.90	Professional		$621.79	$731.60	$843.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $292.80 / $344.40 / $397.30	Professional	26	$292.80	$344.40	$397.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $329.10 / $387.10 / $446.60	Professional	TC	$329.10	$387.10	$446.60