Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $19.50 / $28.18	Facility	26	$10.96	$19.50	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $89.13 / $251.19	Professional		$44.67	$89.13	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $26.30 / $77.62	Professional	26	$10.96	$26.30	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $54.95 / $147.91	Professional	TC	$33.11	$54.95	$147.91
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 $64.57 / $128.82 / $162.18	Professional		$64.57	$128.82	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $30.20 / $38.90	Professional	26	$16.60	$30.20	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $100.00 / $123.03	Professional	TC	$47.86	$100.00	$123.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $79.43 / $234.42	Professional		$48.98	$79.43	$234.42
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $21.88 / $50.12	Professional	26	$12.30	$21.88	$50.12
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $54.95 / $186.21	Professional	TC	$36.31	$54.95	$186.21
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $109.65 / $109.65	Facility	26	$50.12	$109.65	$109.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $87.10 / $346.74	Professional		$50.12	$87.10	$346.74
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $21.38 / $114.82	Professional	26	$14.13	$21.38	$114.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $47.86 / $257.04	Professional	TC	$33.11	$47.86	$257.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $114.82 / $134.90	Professional		$102.33	$114.82	$134.90
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $32.36 / $39.81	Professional	26	$25.70	$32.36	$39.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $87.10 / $102.33	Professional	TC	$67.61	$87.10	$102.33
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 $89.13 / $102.33 / $131.83	Professional		$89.13	$102.33	$131.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $32.36 / $45.71	Professional	26	$30.20	$32.36	$45.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $95.50 / $100.00	Professional	TC	$56.23	$95.50	$100.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $43.65 / $93.33	Professional		$13.80	$43.65	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $60.26 / $109.65	Professional		$46.77	$60.26	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $16.98 / $32.36	Professional	26	$13.49	$16.98	$32.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $41.69 / $81.28	Professional	TC	$33.11	$41.69	$81.28
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $109.65	Professional		$93.33	$93.33	$109.65
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $22.39 / $26.30	Professional	26	$22.39	$22.39	$26.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $70.79 / $83.18	Professional	TC	$70.79	$70.79	$83.18