Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.93 / $18.88 / $35.38	Facility	26	$9.93	$18.88	$35.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.20 / $107.20 / $387.89	Facility	TC	$34.20	$107.20	$387.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $53.75 / $212.00	Professional		$18.62	$53.75	$212.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $16.57 / $59.20	Professional	26	$9.94	$16.57	$59.20
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $80.95 / $124.11 / $253.14	Professional	50	$80.95	$124.11	$253.14
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.38 / $21.16 / $29.22	Professional	52	$18.38	$21.16	$29.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.87 / $41.74 / $132.80	Professional	TC	$29.87	$41.74	$132.80
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.60 / $37.70 / $38.79	Facility	26	$36.60	$37.70	$38.79
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $99.87 / $102.87 / $105.86	Facility	TC	$99.87	$102.87	$105.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.73 / $110.93 / $138.66	Professional		$41.73	$110.93	$138.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.67 / $24.82 / $34.52	Professional	26	$11.67	$24.82	$34.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.23 / $84.61 / $107.63	Professional	TC	$28.23	$84.61	$107.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.18 / $61.78 / $125.34	Professional		$41.18	$61.78	$125.34
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.25 / $16.14 / $36.90	Professional	26	$10.25	$16.14	$36.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.93 / $46.61 / $68.95	Professional	TC	$30.93	$46.61	$68.95
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $37.70 / $100.00 / $100.00	Facility	26	$37.70	$100.00	$100.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $102.87 / $165.02 / $196.91	Facility	TC	$102.87	$165.02	$196.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $40.65 / $66.26 / $297.63	Professional		$40.65	$66.26	$297.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $14.46 / $87.52	Professional	26	$11.04	$14.46	$87.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.52 / $39.13 / $229.42	Professional	TC	$28.52	$39.13	$229.42
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $37.70 / $38.79 / $61.86	Facility	26	$37.70	$38.79	$61.86
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $102.87 / $105.86 / $195.18	Facility	TC	$102.87	$105.86	$195.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $63.00 / $92.09 / $123.13	Professional		$63.00	$92.09	$123.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.07 / $42.26 / $82.43	Professional		$11.07	$42.26	$82.43
United Facility/Professional Professional Modifier Low / Median / High Price $40.65 / $50.81 / $87.06	Professional		$40.65	$50.81	$87.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $13.25 / $23.14	Professional	26	$11.04	$13.25	$23.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.61 / $37.76 / $60.33	Professional	TC	$29.61	$37.76	$60.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $64.06 / $81.09 / $95.40	Professional		$64.06	$81.09	$95.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.85 / $18.80 / $22.20	Professional	26	$14.85	$18.80	$22.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $49.14 / $62.20 / $73.20	Professional	TC	$49.14	$62.20	$73.20