Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $56.23	Facility	26	$10.00	$10.00	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $44.67 / $147.91	Professional		$34.67	$44.67	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.02 / $29.51	Professional	26	$8.91	$12.02	$29.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.11 / $79.43	Professional	TC	$25.12	$33.11	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $33.88 / $34.67	Facility	26	$32.36	$33.88	$34.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $107.15 / $131.83	Professional		$57.54	$107.15	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $26.92 / $33.88	Professional	26	$13.80	$26.92	$33.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $79.43 / $100.00	Professional	TC	$43.65	$79.43	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $67.61 / $173.78	Professional		$40.74	$67.61	$173.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.98 / $45.71	Professional	26	$10.96	$16.98	$45.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $134.90	Professional	TC	$28.18	$44.67	$134.90
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $102.33 / $102.33	Facility	26	$33.88	$102.33	$102.33
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $77.62 / $288.40	Professional		$42.66	$77.62	$288.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $16.98 / $107.15	Professional	26	$11.48	$16.98	$107.15
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $41.69 / $269.15	Professional	TC	$28.84	$41.69	$269.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $95.50 / $120.23	Professional		$87.10	$95.50	$120.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $25.70 / $34.67	Professional	26	$22.39	$25.70	$34.67
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $70.79 / $85.11	Professional	TC	$63.10	$70.79	$85.11
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $34.67 / $34.67	Facility	26	$34.67	$34.67	$34.67
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $89.13 / $109.65	Professional		$75.86	$89.13	$109.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $27.54 / $32.36	Professional	26	$20.89	$27.54	$32.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $81.28	Professional	TC	$53.70	$69.18	$81.28
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $33.88 / $74.13	Professional		$11.75	$33.88	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $50.12 / $93.33	Professional		$39.81	$50.12	$93.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.45 / $25.70	Professional	26	$11.75	$14.45	$25.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $36.31 / $67.61	Professional	TC	$28.18	$36.31	$67.61
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $89.13	Professional		$75.86	$75.86	$89.13
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $19.95 / $23.44	Professional	26	$19.95	$19.95	$23.44
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $56.23 / $66.07	Professional	TC	$56.23	$56.23	$66.07