Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $7.94 / $12.02	Facility	26	$7.94	$7.94	$12.02
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $63.10 / $95.50	Facility	TC	$19.95	$63.10	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $38.02 / $134.90	Professional		$10.47	$38.02	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $10.23 / $42.66	Professional	26	$7.24	$10.23	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $22.91 / $89.13	Professional	TC	$16.98	$22.91	$89.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.90 / $39.81	Facility	26	$38.02	$38.90	$39.81
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $77.62 / $79.43 / $83.18	Facility	TC	$77.62	$79.43	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $79.43 / $100.00	Professional		$35.48	$79.43	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $20.42 / $25.70	Professional	26	$11.22	$20.42	$25.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $58.88 / $74.13	Professional	TC	$23.44	$58.88	$74.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $53.70 / $128.82	Professional		$32.36	$53.70	$128.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $13.80 / $40.74	Professional	26	$9.12	$13.80	$40.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $30.90 / $74.13	Professional	TC	$21.88	$30.90	$74.13
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $70.79 / $70.79	Facility	26	$38.90	$70.79	$70.79
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $79.43 / $109.65 / $109.65	Facility	TC	$79.43	$109.65	$109.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $52.48 / $208.93	Professional		$29.51	$52.48	$208.93
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $12.02 / $57.54	Professional	26	$9.33	$12.02	$57.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $26.30 / $151.36	Professional	TC	$19.05	$26.30	$151.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $83.18	Professional		$54.95	$70.79	$83.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $20.89 / $25.70	Professional	26	$18.20	$20.89	$25.70
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $52.48 / $60.26	Professional	TC	$36.31	$52.48	$60.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $39.81 / $39.81	Facility	26	$39.81	$39.81	$39.81
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	TC	$83.18	$83.18	$83.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $77.62 / $83.18	Professional		$57.54	$77.62	$83.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $20.89 / $25.70	Professional	26	$19.50	$20.89	$25.70
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $57.54 / $60.26	Professional	TC	$38.02	$57.54	$60.26
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.33 / $25.70 / $57.54	Professional		$9.33	$25.70	$57.54
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $37.15 / $67.61	Professional		$29.51	$37.15	$67.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $11.75 / $21.38	Professional	26	$9.33	$11.75	$21.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $25.12 / $47.86	Professional	TC	$19.05	$25.12	$47.86
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $67.61	Professional		$57.54	$57.54	$67.61
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $15.49 / $18.20	Professional	26	$15.49	$15.49	$18.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $41.69 / $48.98	Professional	TC	$41.69	$41.69	$48.98