Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $17.78 / $21.38	Facility	26	$8.91	$17.78	$21.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $48.98 / $186.21	Professional		$28.84	$48.98	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $14.13 / $42.66	Professional	26	$7.94	$14.13	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $25.70 / $109.65	Professional	TC	$19.05	$25.70	$109.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $35.48 / $36.31	Facility	26	$34.67	$35.48	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $83.18 / $102.33	Professional		$45.71	$83.18	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $22.91 / $28.84	Professional	26	$13.18	$22.91	$28.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $58.88 / $74.13	Professional	TC	$31.62	$58.88	$74.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $147.91	Professional		$30.90	$52.48	$147.91
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $16.22 / $46.77	Professional	26	$9.33	$16.22	$46.77
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $35.48 / $109.65	Professional	TC	$21.88	$35.48	$109.65
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $100.00 / $100.00	Facility	26	$35.48	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $61.66 / $223.87	Professional		$33.88	$61.66	$223.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $15.85 / $93.33	Professional	26	$10.72	$15.85	$93.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $31.62 / $208.93	Professional	TC	$20.89	$31.62	$208.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $74.13 / $112.20	Professional		$67.61	$74.13	$112.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $23.44 / $33.88	Professional	26	$20.42	$23.44	$33.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $52.48 / $79.43	Professional	TC	$46.77	$52.48	$79.43
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Facility	26	$36.31	$36.31	$36.31
Midlands Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $74.13 / $87.10	Professional		$58.88	$74.13	$87.10
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $23.44 / $32.36	Professional	26	$22.39	$23.44	$32.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $51.29 / $61.66	Professional	TC	$37.15	$51.29	$61.66
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $25.70 / $58.88	Professional		$10.47	$25.70	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $40.74 / $74.13	Professional		$31.62	$40.74	$74.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $13.49 / $24.55	Professional	26	$10.72	$13.49	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $27.54 / $48.98	Professional	TC	$20.89	$27.54	$48.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $69.18	Professional		$58.88	$58.88	$69.18
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $16.98 / $20.42	Professional	26	$16.98	$16.98	$20.42
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $42.66 / $50.12	Professional	TC	$42.66	$42.66	$50.12