Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $12.02 / $26.92	Facility	26	$10.96	$12.02	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $72.44 / $269.15	Professional		$42.66	$72.44	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $21.38 / $72.44	Professional	26	$10.96	$21.38	$72.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $120.23	Professional	TC	$32.36	$47.86	$120.23
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 / $125.89 / $154.88	Professional		$64.57	$125.89	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $29.51 / $39.81	Professional	26	$16.22	$29.51	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $95.50 / $120.23	Professional	TC	$46.77	$95.50	$120.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $77.62 / $181.97	Professional		$46.77	$77.62	$181.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $21.38 / $47.86	Professional	26	$11.75	$21.38	$47.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $54.95 / $134.90	Professional	TC	$34.67	$54.95	$134.90
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 $48.98 / $87.10 / $331.13	Professional		$48.98	$87.10	$331.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.89 / $120.23	Professional	26	$13.49	$20.89	$120.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $295.12	Professional	TC	$32.36	$47.86	$295.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $165.96	Professional		$102.33	$128.82	$165.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $30.90 / $41.69	Professional	26	$25.12	$30.90	$41.69
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $97.72 / $125.89	Professional	TC	$75.86	$97.72	$125.89
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 $95.50 / $102.33 / $128.82	Professional		$95.50	$102.33	$128.82
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $30.90 / $45.71	Professional	26	$29.51	$30.90	$45.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $75.86 / $97.72	Professional	TC	$63.10	$75.86	$97.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $41.69 / $91.20	Professional		$13.49	$41.69	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $58.88 / $109.65	Professional		$46.77	$58.88	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.60 / $31.62	Professional	26	$12.88	$16.60	$31.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $41.69 / $77.62	Professional	TC	$32.36	$41.69	$77.62
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $104.71	Professional		$89.13	$89.13	$104.71
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $25.70	Professional	26	$21.88	$21.88	$25.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $67.61 / $79.43	Professional	TC	$67.61	$67.61	$79.43