Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.54 / $17.54 / $17.54	Facility	26	$17.54	$17.54	$17.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $35.13 / $88.07 / $110.50	Facility	TC	$35.13	$88.07	$110.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.39 / $39.39 / $86.07	Professional		$35.39	$39.39	$86.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $12.64 / $26.60	Professional	26	$11.40	$12.64	$26.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.85 / $25.94 / $36.52	Professional	TC	$22.85	$25.94	$36.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.66 / $46.00 / $47.34	Facility	26	$44.66	$46.00	$47.34
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $78.06 / $80.40 / $82.74	Facility	TC	$78.06	$80.40	$82.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.15 / $97.74 / $122.17	Professional		$40.15	$97.74	$122.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.05 / $29.48 / $36.85	Professional	26	$13.05	$29.48	$36.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.24 / $68.26 / $85.33	Professional	TC	$25.24	$68.26	$85.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.45 / $57.36 / $167.18	Professional		$41.45	$57.36	$167.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.39 / $18.64 / $61.51	Professional	26	$13.39	$18.64	$61.51
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.39 / $38.72 / $86.68	Professional	TC	$28.39	$38.72	$86.68
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $46.00 / $70.00 / $70.00	Facility	26	$46.00	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $80.40 / $131.69 / $131.69	Facility	TC	$80.40	$131.69	$131.69
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.02 / $57.80 / $271.47	Professional		$39.02	$57.80	$271.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $17.57 / $81.06	Professional	26	$13.50	$17.57	$81.06
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.57 / $32.59 / $190.40	Professional	TC	$24.57	$32.59	$190.40
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $46.00 / $47.34 / $73.44	Facility	26	$46.00	$47.34	$73.44
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $80.40 / $82.74 / $157.32	Facility	TC	$80.40	$82.74	$157.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $70.77 / $89.67 / $142.66	Professional		$70.77	$89.67	$142.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.74 / $29.66 / $69.06	Professional		$12.74	$29.66	$69.06
United Facility/Professional Professional Modifier Low / Median / High Price $38.53 / $49.88 / $79.34	Professional		$38.53	$49.88	$79.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $17.57 / $32.99	Professional	26	$13.50	$17.57	$32.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.03 / $32.59 / $50.99	Professional	TC	$25.03	$32.59	$50.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $56.80 / $71.90 / $84.60	Professional		$56.80	$71.90	$84.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.62 / $22.30 / $26.20	Professional	26	$17.62	$22.30	$26.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $39.26 / $49.70 / $58.40	Professional	TC	$39.26	$49.70	$58.40