Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.02 / $23.02 / $85.06	Facility	26	$23.02	$23.02	$85.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $50.93 / $76.97 / $118.07	Facility	TC	$50.93	$76.97	$118.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.28 / $45.24 / $125.00	Professional		$38.28	$45.24	$125.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.69 / $14.49 / $60.52	Professional	26	$11.69	$14.49	$60.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.59 / $29.89 / $58.21	Professional	TC	$26.59	$29.89	$58.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.13 / $51.63 / $53.14	Facility	26	$50.13	$51.63	$53.14
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $96.69 / $99.59 / $102.49	Facility	TC	$96.69	$99.59	$102.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.33 / $103.94 / $146.51	Professional		$46.33	$103.94	$146.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.09 / $30.96 / $45.61	Professional	26	$15.09	$30.96	$45.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.95 / $73.69 / $100.90	Professional	TC	$30.95	$73.69	$100.90
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $39.15 / $67.26 / $139.37	Professional		$39.15	$67.26	$139.37
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.47 / $22.53 / $45.89	Professional	26	$12.47	$22.53	$45.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.68 / $45.55 / $85.23	Professional	TC	$26.68	$45.55	$85.23
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $51.63 / $100.00 / $100.00	Facility	26	$51.63	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $99.59 / $142.32 / $142.32	Facility	TC	$99.59	$142.32	$142.32
Medica Facility/Professional Professional Modifier Low / Median / High Price $45.30 / $78.00 / $314.00	Professional		$45.30	$78.00	$314.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.80 / $19.30 / $107.32	Professional	26	$14.80	$19.30	$107.32
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.30 / $35.94 / $296.00	Professional	TC	$28.30	$35.94	$296.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $51.63 / $53.14 / $75.42	Facility	26	$51.63	$53.14	$75.42
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $99.59 / $102.49 / $168.12	Facility	TC	$99.59	$102.49	$168.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $83.62 / $95.35 / $151.69	Professional		$83.62	$95.35	$151.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.35 / $40.07 / $73.48	Professional		$13.35	$40.07	$73.48
United Facility/Professional Professional Modifier Low / Median / High Price $41.18 / $53.62 / $89.31	Professional		$41.18	$53.62	$89.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.19 / $18.48 / $30.44	Professional	26	$14.19	$18.48	$30.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.30 / $35.14 / $57.66	Professional	TC	$28.30	$35.14	$57.66
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $60.44 / $76.50 / $90.00	Professional		$60.44	$76.50	$90.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.01 / $22.80 / $26.90	Professional	26	$18.01	$22.80	$26.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $42.42 / $53.70 / $63.10	Professional	TC	$42.42	$53.70	$63.10