Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.60 / $13.66 / $13.66	Facility	26	$10.60	$13.66	$13.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.59 / $52.58 / $78.14	Facility	TC	$34.59	$52.58	$78.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.11 / $27.26 / $90.24	Professional		$25.11	$27.26	$90.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $7.85 / $33.00	Professional	26	$7.00	$7.85	$33.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.67 / $19.00 / $40.54	Professional	TC	$17.67	$19.00	$40.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.36 / $28.18 / $29.00	Facility	26	$27.36	$28.18	$29.00
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $61.52 / $63.37 / $65.20	Facility	TC	$61.52	$63.37	$65.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $28.36 / $69.04 / $86.30	Professional		$28.36	$69.04	$86.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.07 / $17.84 / $22.30	Professional	26	$8.07	$17.84	$22.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.48 / $51.20 / $64.00	Professional	TC	$19.48	$51.20	$64.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $29.08 / $40.52 / $119.65	Professional		$29.08	$40.52	$119.65
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.16 / $11.54 / $33.83	Professional	26	$8.16	$11.54	$33.83
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.16 / $29.00 / $60.35	Professional	TC	$21.16	$29.00	$60.35
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $70.00 / $70.00	Facility	26	$28.18	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $63.37 / $98.42 / $98.42	Facility	TC	$63.37	$98.42	$98.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $27.40 / $41.43 / $130.71	Professional		$27.40	$41.43	$130.71
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $10.71 / $51.02	Professional	26	$8.23	$10.71	$51.02
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.80 / $24.49 / $136.11	Professional	TC	$18.80	$24.49	$136.11
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $29.00 / $44.64	Facility	26	$28.18	$29.00	$44.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $63.37 / $65.20 / $114.12	Facility	TC	$63.37	$65.20	$114.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $49.60 / $61.73 / $97.24	Professional		$49.60	$61.73	$97.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.18 / $27.00 / $49.50	Professional		$8.18	$27.00	$49.50
United Facility/Professional Professional Modifier Low / Median / High Price $27.03 / $32.93 / $54.62	Professional		$27.03	$32.93	$54.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.23 / $10.71 / $17.63	Professional	26	$8.23	$10.71	$17.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.80 / $22.57 / $38.31	Professional	TC	$18.80	$22.57	$38.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $40.13 / $50.80 / $59.80	Professional		$40.13	$50.80	$59.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $10.82 / $13.70 / $16.10	Professional	26	$10.82	$13.70	$16.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $29.31 / $37.10 / $43.70	Professional	TC	$29.31	$37.10	$43.70