Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $22.91 / $27.54	Facility	26	$10.96	$22.91	$27.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $47.86 / $186.21	Professional		$19.50	$47.86	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.05 / $50.12	Professional	26	$10.96	$19.05	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.02 / $123.03	Professional	TC	$23.99	$38.02	$123.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $40.74 / $42.66	Facility	26	$39.81	$40.74	$42.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $100.00 / $125.89	Professional		$51.29	$100.00	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $29.51 / $36.31	Professional	26	$16.22	$29.51	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $70.79 / $89.13	Professional	TC	$33.88	$70.79	$89.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $61.66 / $147.91	Professional		$38.02	$61.66	$147.91
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.95 / $61.66	Professional	26	$11.75	$19.95	$61.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $39.81 / $83.18	Professional	TC	$26.30	$39.81	$83.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $100.00 / $100.00	Facility	26	$40.74	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $70.79 / $269.15	Professional		$38.02	$70.79	$269.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $19.95 / $93.33	Professional	26	$13.49	$19.95	$93.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $35.48 / $229.09	Professional	TC	$23.99	$35.48	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $89.13 / $107.15	Professional		$79.43	$89.13	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $30.90 / $37.15	Professional	26	$25.70	$30.90	$37.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $63.10 / $74.13	Professional	TC	$53.70	$63.10	$74.13
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $42.66 / $42.66	Facility	26	$42.66	$42.66	$42.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $79.43 / $104.71	Professional		$70.79	$79.43	$104.71
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $29.51 / $40.74	Professional	26	$25.70	$29.51	$40.74
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $53.70 / $74.13	Professional	TC	$42.66	$53.70	$74.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $37.15 / $70.79	Professional		$13.49	$37.15	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $47.86 / $89.13	Professional		$38.02	$47.86	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.22 / $30.20	Professional	26	$13.18	$16.22	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $30.90 / $58.88	Professional	TC	$23.99	$30.90	$58.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $85.11	Professional		$72.44	$72.44	$85.11
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $25.70	Professional	26	$21.88	$21.88	$25.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $58.88	Professional	TC	$50.12	$50.12	$58.88