Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.20 / $20.20 / $20.20	Facility	26	$20.20	$20.20	$20.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.94 / $95.12 / $119.35	Facility	TC	$37.94	$95.12	$119.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.95 / $43.48 / $188.80	Professional		$37.95	$43.48	$188.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.15 / $14.44 / $22.75	Professional	26	$13.15	$14.44	$22.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $27.10 / $39.01	Professional	TC	$23.51	$27.10	$39.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.33 / $52.87 / $54.41	Facility	26	$51.33	$52.87	$54.41
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $80.30 / $82.71 / $85.12	Facility	TC	$80.30	$82.71	$85.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.68 / $106.27 / $132.84	Professional		$43.68	$106.27	$132.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.71 / $33.36 / $41.69	Professional	26	$14.71	$33.36	$41.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.96 / $72.92 / $91.14	Professional	TC	$25.96	$72.92	$91.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $45.14 / $62.40 / $179.93	Professional		$45.14	$62.40	$179.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.09 / $21.02 / $72.28	Professional	26	$15.09	$21.02	$72.28
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.35 / $41.39 / $87.21	Professional	TC	$30.35	$41.39	$87.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $52.87 / $70.00 / $70.00	Facility	26	$52.87	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $82.71 / $140.77 / $140.77	Facility	TC	$82.71	$140.77	$140.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $41.98 / $62.91 / $297.38	Professional		$41.98	$62.91	$297.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $20.73 / $93.99	Professional	26	$15.92	$20.73	$93.99
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.27 / $33.88 / $203.39	Professional	TC	$25.27	$33.88	$203.39
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $52.87 / $54.41 / $81.30	Facility	26	$52.87	$54.41	$81.30
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $82.71 / $85.12 / $168.12	Facility	TC	$82.71	$85.12	$168.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $76.61 / $97.48 / $153.94	Professional		$76.61	$97.48	$153.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.72 / $41.04 / $76.20	Professional		$14.72	$41.04	$76.20
United Facility/Professional Professional Modifier Low / Median / High Price $41.94 / $54.61 / $84.50	Professional		$41.94	$54.61	$84.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.92 / $19.73 / $33.39	Professional	26	$15.92	$19.73	$33.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.94 / $31.22 / $53.00	Professional	TC	$25.94	$31.22	$53.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $61.78 / $78.20 / $92.00	Professional		$61.78	$78.20	$92.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $19.82 / $25.10 / $29.60	Professional	26	$19.82	$25.10	$29.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $41.95 / $53.10 / $62.50	Professional	TC	$41.95	$53.10	$62.50