Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $10.72 / $16.98	Facility	26	$7.08	$10.72	$16.98
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.20 / $56.23 / $75.86	Facility	TC	$18.20	$56.23	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $28.84 / $91.20	Professional		$19.05	$28.84	$91.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $9.33 / $44.67	Professional	26	$6.03	$9.33	$44.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $19.95 / $58.88	Professional	TC	$15.85	$19.95	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $28.18 / $28.84	Facility	26	$27.54	$28.18	$28.84
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $61.66 / $63.10 / $64.57	Facility	TC	$61.66	$63.10	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $70.79 / $89.13	Professional		$33.11	$70.79	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $18.20 / $22.91	Professional	26	$10.00	$18.20	$22.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $52.48 / $66.07	Professional	TC	$22.39	$52.48	$66.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $44.67 / $120.23	Professional		$28.84	$44.67	$120.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $10.72 / $33.88	Professional	26	$7.41	$10.72	$33.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $27.54 / $83.18	Professional	TC	$19.05	$27.54	$83.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $70.79 / $70.79	Facility	26	$28.18	$70.79	$70.79
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $63.10 / $97.72 / $97.72	Facility	TC	$63.10	$97.72	$97.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $47.86 / $186.21	Professional		$27.54	$47.86	$186.21
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $10.72 / $51.29	Professional	26	$8.32	$10.72	$51.29
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.12 / $134.90	Professional	TC	$18.62	$25.12	$134.90
Midlands Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $63.10 / $72.44	Professional		$51.29	$63.10	$72.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $18.62 / $19.95	Professional	26	$16.22	$18.62	$19.95
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $46.77 / $52.48	Professional	TC	$35.48	$46.77	$52.48
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $28.84 / $28.84	Facility	26	$28.84	$28.84	$28.84
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $64.57 / $64.57 / $64.57	Facility	TC	$64.57	$64.57	$64.57
Midlands Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $69.18 / $72.44	Professional		$53.70	$69.18	$72.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $18.62 / $19.95	Professional	26	$16.98	$18.62	$19.95
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $51.29 / $52.48	Professional	TC	$37.15	$51.29	$52.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.51 / $26.92 / $50.12	Professional		$8.51	$26.92	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.88 / $63.10	Professional		$26.92	$33.88	$63.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.23 / $19.05	Professional	26	$8.13	$10.23	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $23.44 / $43.65	Professional	TC	$18.62	$23.44	$43.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $51.29 / $60.26	Professional		$51.29	$51.29	$60.26
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $13.80 / $16.22	Professional	26	$13.80	$13.80	$16.22
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $37.15 / $43.65	Professional	TC	$37.15	$37.15	$43.65