Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.72 / $24.16 / $24.16	Facility	26	$12.72	$24.16	$24.16
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $47.57 / $67.28 / $145.80	Facility	TC	$47.57	$67.28	$145.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.27 / $51.07 / $217.00	Professional		$44.27	$51.07	$217.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $14.03 / $52.80	Professional	26	$12.42	$14.03	$52.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $76.55 / $76.55 / $99.21	Professional	50	$76.55	$76.55	$99.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.85 / $37.77 / $117.92	Professional	TC	$30.85	$37.77	$117.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.93 / $61.73 / $63.53	Facility	26	$59.93	$61.73	$63.53
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $130.91 / $134.84 / $138.76	Facility	TC	$130.91	$134.84	$138.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.51 / $126.44 / $158.05	Professional		$50.51	$126.44	$158.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.04 / $31.80 / $39.75	Professional	26	$14.04	$31.80	$39.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.86 / $94.64 / $118.29	Professional	TC	$33.86	$94.64	$118.29
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.20 / $73.38 / $166.09	Professional		$53.20	$73.38	$166.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.38 / $20.05 / $71.91	Professional	26	$14.38	$20.05	$71.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.22 / $52.04 / $81.06	Professional	TC	$39.22	$52.04	$81.06
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $61.73 / $70.00 / $70.00	Facility	26	$61.73	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $120.06 / $181.68 / $181.68	Facility	TC	$120.06	$181.68	$181.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $48.42 / $73.77 / $345.18	Professional		$48.42	$73.77	$345.18
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.55 / $18.95 / $89.67	Professional	26	$14.55	$18.95	$89.67
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.94 / $44.10 / $255.46	Professional	TC	$32.94	$44.10	$255.46
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $61.73 / $63.53 / $79.20	Facility	26	$61.73	$63.53	$79.20
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $134.84 / $138.76 / $214.98	Facility	TC	$134.84	$138.76	$214.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.86 / $110.90 / $171.19	Professional		$89.86	$110.90	$171.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $14.06 / $41.76 / $89.41	Professional		$14.06	$41.76	$89.41
United Facility/Professional Professional Modifier Low / Median / High Price $48.42 / $63.00 / $143.31	Professional		$48.42	$63.00	$143.31
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.68 / $18.19 / $30.83	Professional	26	$14.68	$18.19	$30.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.86 / $42.34 / $69.01	Professional	TC	$33.86	$42.34	$69.01
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $73.08 / $92.50 / $108.80	Professional		$73.08	$92.50	$108.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.96 / $24.00 / $28.20	Professional	26	$18.96	$24.00	$28.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $54.12 / $68.50 / $80.59	Professional	TC	$54.12	$68.50	$80.59