Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $21.88 / $26.92	Facility	26	$10.96	$21.88	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $61.66 / $208.93	Professional		$33.88	$61.66	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $22.39 / $61.66	Professional	26	$10.00	$22.39	$61.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.20 / $104.71	Professional	TC	$22.91	$30.20	$104.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $52.48 / $53.70	Facility	26	$50.12	$52.48	$53.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $102.33 / $128.82	Professional		$45.71	$102.33	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $28.84 / $35.48	Professional	26	$15.85	$28.84	$35.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $74.13 / $93.33	Professional	TC	$29.51	$74.13	$93.33
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $64.57 / $169.82	Professional		$42.66	$64.57	$169.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $18.62 / $54.95	Professional	26	$12.59	$18.62	$54.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $44.67 / $123.03	Professional	TC	$29.51	$44.67	$123.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $70.79 / $70.79	Facility	26	$52.48	$70.79	$70.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $67.61 / $275.42	Professional		$38.90	$67.61	$275.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.98 / $79.43	Professional	26	$13.18	$16.98	$79.43
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.88 / $194.98	Professional	TC	$24.55	$33.88	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $91.20 / $107.15	Professional		$72.44	$91.20	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $28.84 / $32.36	Professional	26	$25.12	$28.84	$32.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $66.07 / $75.86	Professional	TC	$45.71	$66.07	$75.86
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Facility	26	$53.70	$53.70	$53.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $100.00 / $107.15	Professional		$75.86	$100.00	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $28.84 / $32.36	Professional	26	$26.92	$28.84	$32.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $72.44 / $75.86	Professional	TC	$48.98	$72.44	$75.86
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $32.36 / $75.86	Professional		$13.49	$32.36	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $47.86 / $91.20	Professional		$38.02	$47.86	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.60 / $30.20	Professional	26	$13.18	$16.60	$30.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $31.62 / $60.26	Professional	TC	$24.55	$31.62	$60.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $87.10	Professional		$74.13	$74.13	$87.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $20.89 / $25.12	Professional	26	$20.89	$20.89	$25.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $61.66	Professional	TC	$52.48	$52.48	$61.66