Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $10.96 / $18.20	Facility	26	$10.96	$10.96	$18.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $64.57 / $199.53	Professional		$38.90	$64.57	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $14.13 / $50.12	Professional	26	$10.96	$14.13	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $43.65 / $158.49	Professional	TC	$33.88	$43.65	$158.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $58.88 / $60.26	Facility	26	$57.54	$58.88	$60.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $144.54 / $181.97	Professional		$61.66	$144.54	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $30.90 / $38.90	Professional	26	$16.98	$30.90	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $114.82 / $144.54	Professional	TC	$43.65	$114.82	$144.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $97.72 / $223.87	Professional		$58.88	$97.72	$223.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.42 / $58.88	Professional	26	$13.49	$20.42	$58.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $60.26 / $138.04	Professional	TC	$42.66	$60.26	$138.04
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $70.79 / $70.79	Facility	26	$58.88	$70.79	$70.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $91.20 / $380.19	Professional		$51.29	$91.20	$380.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $18.20 / $83.18	Professional	26	$13.80	$18.20	$83.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $51.29 / $295.12	Professional	TC	$36.31	$51.29	$295.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $147.91	Professional		$95.50	$128.82	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $30.20 / $38.90	Professional	26	$26.30	$30.20	$38.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $100.00 / $117.49	Professional	TC	$67.61	$100.00	$117.49
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $60.26 / $60.26	Facility	26	$60.26	$60.26	$60.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $141.25 / $147.91	Professional		$100.00	$141.25	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $31.62 / $38.90	Professional	26	$29.51	$31.62	$38.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $112.20 / $117.49	Professional	TC	$70.79	$112.20	$117.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $51.29 / $109.65	Professional		$14.13	$51.29	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $64.57 / $120.23	Professional		$51.29	$64.57	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $16.98 / $31.62	Professional	26	$13.49	$16.98	$31.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $47.86 / $93.33	Professional	TC	$36.31	$47.86	$93.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $123.03	Professional		$104.71	$104.71	$123.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $22.91 / $26.92	Professional	26	$22.91	$22.91	$26.92
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $81.28 / $95.50	Professional	TC	$81.28	$81.28	$95.50