Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $18.20 / $22.91	Facility	26	$8.91	$18.20	$22.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $58.88 / $208.93	Professional		$32.36	$58.88	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $17.78 / $50.12	Professional	26	$8.91	$17.78	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $32.36 / $128.82	Professional	TC	$21.88	$32.36	$128.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $28.84 / $29.51	Facility	26	$27.54	$28.84	$29.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $93.33 / $117.49	Professional		$44.67	$93.33	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $24.55 / $30.90	Professional	26	$11.75	$24.55	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $69.18 / $87.10	Professional	TC	$32.36	$69.18	$87.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $53.70 / $134.90	Professional		$35.48	$53.70	$134.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.49 / $38.90	Professional	26	$10.00	$15.49	$38.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.02 / $107.15	Professional	TC	$25.70	$38.02	$107.15
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $100.00 / $100.00	Facility	26	$28.84	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $63.10 / $251.19	Professional		$34.67	$63.10	$251.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $16.60 / $97.72	Professional	26	$10.23	$16.60	$97.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $181.97	Professional	TC	$22.91	$33.88	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $83.18 / $100.00	Professional		$69.18	$83.18	$100.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $22.91 / $28.84	Professional	26	$19.95	$22.91	$28.84
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $61.66 / $72.44	Professional	TC	$50.12	$61.66	$72.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $29.51 / $29.51	Facility	26	$29.51	$29.51	$29.51
Midlands Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $70.79 / $97.72	Professional		$64.57	$70.79	$97.72
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $25.12 / $28.84	Professional	26	$18.20	$25.12	$28.84
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $52.48 / $72.44	Professional	TC	$44.67	$52.48	$72.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.72 / $29.51 / $66.07	Professional		$10.72	$29.51	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $42.66 / $83.18	Professional		$33.88	$42.66	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $13.80 / $24.55	Professional	26	$10.23	$13.80	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $30.20 / $57.54	Professional	TC	$23.44	$30.20	$57.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $79.43	Professional		$67.61	$67.61	$79.43
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.20 / $21.38	Professional	26	$18.20	$18.20	$21.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $48.98 / $57.54	Professional	TC	$48.98	$48.98	$57.54