Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $20.42 / $30.90	Facility	26	$12.88	$20.42	$30.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $91.20 / $316.23	Professional		$57.54	$91.20	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $28.18 / $74.13	Professional	26	$12.88	$28.18	$74.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $58.88 / $199.53	Professional	TC	$42.66	$58.88	$199.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $63.10 / $64.57	Facility	26	$61.66	$63.10	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $169.82 / $208.93	Professional		$74.13	$169.82	$208.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $34.67 / $43.65	Professional	26	$19.05	$34.67	$43.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $134.90 / $165.96	Professional	TC	$53.70	$134.90	$165.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $107.15 / $125.89	Professional		$69.18	$107.15	$125.89
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $22.91 / $66.07	Professional	26	$15.14	$22.91	$66.07
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $64.57 / $83.18	Professional	TC	$42.66	$64.57	$83.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $70.79 / $70.79	Facility	26	$63.10	$70.79	$70.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $109.65 / $457.09	Professional		$61.66	$109.65	$457.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $20.42 / $95.50	Professional	26	$15.85	$20.42	$95.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $354.81	Professional	TC	$44.67	$61.66	$354.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $177.83	Professional		$114.82	$151.36	$177.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $37.15 / $39.81	Professional	26	$30.20	$37.15	$39.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $117.49 / $141.25	Professional	TC	$83.18	$117.49	$141.25
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	26	$64.57	$64.57	$64.57
Midlands Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $165.96 / $173.78	Professional		$120.23	$165.96	$173.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $35.48 / $39.81	Professional	26	$33.11	$35.48	$39.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $128.82 / $138.04	Professional	TC	$87.10	$128.82	$138.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $58.88 / $125.89	Professional		$15.85	$58.88	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $144.54	Professional		$61.66	$77.62	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.95 / $36.31	Professional	26	$15.85	$19.95	$36.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $58.88 / $109.65	Professional	TC	$44.67	$58.88	$109.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $141.25	Professional		$120.23	$120.23	$141.25
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $30.20	Professional	26	$25.70	$25.70	$30.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $112.20	Professional	TC	$95.50	$95.50	$112.20