Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $23.99	Facility	26	$10.00	$10.00	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $43.65 / $194.98	Professional		$33.11	$43.65	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.14 / $44.67	Professional	26	$10.00	$15.14	$44.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $32.36 / $79.43	Professional	TC	$23.99	$32.36	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.90 / $39.81	Facility	26	$38.02	$38.90	$39.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $104.71 / $128.82	Professional		$51.29	$104.71	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $27.54 / $34.67	Professional	26	$15.14	$27.54	$34.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $75.86 / $95.50	Professional	TC	$35.48	$75.86	$95.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $58.88 / $131.83	Professional		$39.81	$58.88	$131.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.20 / $38.02	Professional	26	$11.22	$18.20	$38.02
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $41.69 / $100.00	Professional	TC	$28.18	$41.69	$100.00
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $100.00 / $100.00	Facility	26	$38.90	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $70.79 / $281.84	Professional		$38.90	$70.79	$281.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $18.62 / $91.20	Professional	26	$12.59	$18.62	$91.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $208.93	Professional	TC	$25.70	$36.31	$208.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $93.33 / $112.20	Professional		$75.86	$93.33	$112.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $28.84 / $38.02	Professional	26	$23.99	$28.84	$38.02
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $61.66 / $81.28	Professional	TC	$52.48	$61.66	$81.28
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	26	$39.81	$39.81	$39.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $81.28 / $107.15	Professional		$38.90	$81.28	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $25.70 / $28.84	Professional	26	$23.99	$25.70	$28.84
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $56.23 / $79.43	Professional	TC	$47.86	$56.23	$79.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $32.36 / $72.44	Professional		$12.02	$32.36	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $48.98 / $91.20	Professional		$38.02	$48.98	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $15.49 / $28.84	Professional	26	$12.59	$15.49	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $33.11 / $63.10	Professional	TC	$25.70	$33.11	$63.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $87.10	Professional		$74.13	$74.13	$87.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $20.42 / $23.99	Professional	26	$20.42	$20.42	$23.99
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $63.10	Professional	TC	$53.70	$53.70	$63.10