Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $27.54 / $33.11	Facility	26	$12.88	$27.54	$33.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $60.26 / $269.15	Professional		$41.69	$60.26	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $23.99 / $58.88	Professional	26	$12.88	$23.99	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $125.89	Professional	TC	$28.84	$38.90	$125.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $50.12 / $51.29	Facility	26	$47.86	$50.12	$51.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $125.89 / $158.49	Professional		$66.07	$125.89	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $35.48 / $44.67	Professional	26	$19.50	$35.48	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $89.13 / $112.20	Professional	TC	$44.67	$89.13	$112.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $77.62 / $173.78	Professional		$46.77	$77.62	$173.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $23.44 / $53.70	Professional	26	$14.45	$23.44	$53.70
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $53.70 / $131.83	Professional	TC	$33.11	$53.70	$131.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $100.00 / $100.00	Facility	26	$50.12	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $93.33 / $338.84	Professional		$50.12	$93.33	$338.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $23.99 / $117.49	Professional	26	$15.85	$23.99	$117.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $45.71 / $288.40	Professional	TC	$31.62	$45.71	$288.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $112.20 / $134.90	Professional		$102.33	$112.20	$134.90
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $38.02 / $46.77	Professional	26	$30.90	$38.02	$46.77
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $79.43 / $95.50	Professional	TC	$70.79	$79.43	$95.50
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $107.15 / $131.83	Professional		$93.33	$107.15	$131.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $36.31 / $47.86	Professional	26	$30.90	$36.31	$47.86
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $77.62 / $93.33	Professional	TC	$60.26	$77.62	$93.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $46.77 / $87.10	Professional		$15.85	$46.77	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $60.26 / $112.20	Professional		$47.86	$60.26	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.50 / $36.31	Professional	26	$15.85	$19.50	$36.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $40.74 / $74.13	Professional	TC	$31.62	$40.74	$74.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $104.71	Professional		$89.13	$89.13	$104.71
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $26.30 / $30.90	Professional	26	$26.30	$26.30	$30.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $74.13	Professional	TC	$63.10	$63.10	$74.13