Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.33 / $15.40 / $15.40	Facility	26	$8.33	$15.40	$15.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.41 / $40.59 / $90.28	Facility	TC	$21.41	$40.59	$90.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.73 / $31.45 / $135.19	Professional		$21.73	$31.45	$135.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.88 / $8.84 / $37.60	Professional	26	$7.88	$8.84	$37.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.32 / $21.20 / $54.87	Professional	TC	$18.32	$21.20	$54.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.64 / $38.77 / $39.90	Facility	26	$37.64	$38.77	$39.90
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $78.00 / $80.34 / $82.68	Facility	TC	$78.00	$80.34	$82.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.62 / $77.56 / $96.96	Professional		$30.62	$77.56	$96.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.06 / $20.17 / $25.21	Professional	26	$9.06	$20.17	$25.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.20 / $57.40 / $71.75	Professional	TC	$20.20	$57.40	$71.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $32.71 / $45.48 / $116.00	Professional		$32.71	$45.48	$116.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.16 / $12.95 / $46.13	Professional	26	$9.16	$12.95	$46.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.79 / $32.54 / $54.41	Professional	TC	$23.79	$32.54	$54.41
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $38.77 / $70.00 / $70.00	Facility	26	$38.77	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $80.34 / $110.49 / $110.49	Facility	TC	$80.34	$110.49	$110.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.39 / $44.97 / $139.06	Professional		$29.39	$44.97	$139.06
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $12.07 / $57.45	Professional	26	$9.27	$12.07	$57.45
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.69 / $26.20 / $151.32	Professional	TC	$19.69	$26.20	$151.32
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $38.77 / $39.90 / $50.40	Facility	26	$38.77	$39.90	$50.40
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $80.34 / $82.68 / $128.52	Facility	TC	$80.34	$82.68	$128.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $54.67 / $68.36 / $103.69	Professional		$54.67	$68.36	$103.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.08 / $25.63 / $55.39	Professional		$9.08	$25.63	$55.39
United Facility/Professional Professional Modifier Low / Median / High Price $29.39 / $35.27 / $60.25	Professional		$29.39	$35.27	$60.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.27 / $11.13 / $18.97	Professional	26	$9.27	$11.13	$18.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.12 / $25.18 / $44.08	Professional	TC	$20.12	$25.18	$44.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $45.11 / $57.10 / $67.20	Professional		$45.11	$57.10	$67.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $12.17 / $15.40 / $18.10	Professional	26	$12.17	$15.40	$18.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $32.94 / $41.70 / $49.00	Professional	TC	$32.94	$41.70	$49.00