Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.95 / $11.32 / $21.17	Facility	26	$5.95	$11.32	$21.17
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.02 / $115.04 / $329.63	Facility	TC	$30.02	$115.04	$329.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $36.38 / $164.00	Professional		$15.14	$36.38	$164.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.96 / $8.99 / $35.81	Professional	26	$5.96	$8.99	$35.81
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $63.64 / $63.64 / $106.40	Professional	50	$63.64	$63.64	$106.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.85 / $16.44 / $27.75	Professional	52	$14.85	$16.44	$27.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $31.64 / $67.31	Professional	TC	$25.57	$31.64	$67.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.75 / $21.37 / $22.00	Facility	26	$20.75	$21.37	$22.00
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $80.78 / $83.20 / $85.63	Facility	TC	$80.78	$83.20	$85.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.61 / $84.01 / $111.51	Professional		$29.61	$84.01	$111.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.13 / $14.74 / $18.42	Professional	26	$7.13	$14.74	$18.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.82 / $67.61 / $93.08	Professional	TC	$22.82	$67.61	$93.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $33.15 / $47.35 / $99.55	Professional		$33.15	$47.35	$99.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.20 / $9.63 / $25.67	Professional	26	$6.20	$9.63	$25.67
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.96 / $35.90 / $61.18	Professional	TC	$24.96	$35.90	$61.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $21.37 / $100.00 / $100.00	Facility	26	$21.37	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $67.18 / $143.82 / $143.82	Facility	TC	$67.18	$143.82	$143.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.82 / $50.68 / $241.48	Professional		$32.82	$50.68	$241.48
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $6.86 / $8.86 / $51.19	Professional	26	$6.86	$8.86	$51.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.71 / $34.36 / $199.06	Professional	TC	$24.71	$34.36	$199.06
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $21.37 / $22.00 / $36.96	Facility	26	$21.37	$22.00	$36.96
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $83.20 / $85.63 / $169.92	Facility	TC	$83.20	$85.63	$169.92
Midlands Facility/Professional Professional Modifier Low / Median / High Price $41.00 / $74.16 / $95.32	Professional		$41.00	$74.16	$95.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $6.86 / $34.03 / $65.69	Professional		$6.86	$34.03	$65.69
United Facility/Professional Professional Modifier Low / Median / High Price $31.18 / $42.74 / $70.45	Professional		$31.18	$42.74	$70.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.81 / $8.52 / $13.94	Professional	26	$6.81	$8.52	$13.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.01 / $33.86 / $52.98	Professional	TC	$26.01	$33.86	$52.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $51.90 / $65.70 / $77.20	Professional		$51.90	$65.70	$77.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $9.01 / $11.40 / $13.40	Professional	26	$9.01	$11.40	$13.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $42.82 / $54.20 / $63.80	Professional	TC	$42.82	$54.20	$63.80