Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.97 / $14.44 / $18.94	Facility	26	$9.97	$14.44	$18.94
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.89 / $138.08 / $362.97	Facility	TC	$22.89	$138.08	$362.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $35.90 / $186.00	Professional		$30.19	$35.90	$186.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.97 / $12.95 / $43.12	Professional	26	$9.97	$12.95	$43.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.82 / $25.63 / $75.20	Professional	TC	$21.82	$25.63	$75.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.19 / $47.58 / $48.96	Facility	26	$46.19	$47.58	$48.96
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $85.29 / $87.85 / $90.41	Facility	TC	$85.29	$87.85	$90.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.77 / $86.10 / $107.63	Professional		$34.77	$86.10	$107.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.07 / $24.82 / $31.03	Professional	26	$11.07	$24.82	$31.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.00 / $61.28 / $76.59	Professional	TC	$22.00	$61.28	$76.59
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $36.44 / $50.55 / $106.63	Professional		$36.44	$50.55	$106.63
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.31 / $15.81 / $42.32	Professional	26	$11.31	$15.81	$42.32
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.43 / $34.74 / $61.18	Professional	TC	$25.43	$34.74	$61.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $47.58 / $70.00 / $70.00	Facility	26	$47.58	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $87.85 / $118.08 / $188.97	Facility	TC	$87.85	$118.08	$188.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $33.47 / $51.03 / $157.50	Professional		$33.47	$51.03	$157.50
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $14.85 / $70.37	Professional	26	$11.40	$14.85	$70.37
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.43 / $28.75 / $166.53	Professional	TC	$21.43	$28.75	$166.53
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $47.58 / $48.96 / $60.18	Facility	26	$47.58	$48.96	$60.18
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $87.85 / $90.41 / $139.32	Facility	TC	$87.85	$90.41	$139.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $61.80 / $78.52 / $122.11	Professional		$61.80	$78.52	$122.11
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $11.05 / $33.13 / $60.71	Professional		$11.05	$33.13	$60.71
United Facility/Professional Professional Modifier Low / Median / High Price $33.29 / $41.52 / $72.58	Professional		$33.29	$41.52	$72.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.40 / $14.10 / $23.90	Professional	26	$11.40	$14.10	$23.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.43 / $27.27 / $44.97	Professional	TC	$21.43	$27.27	$44.97
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $50.09 / $63.40 / $74.59	Professional		$50.09	$63.40	$74.59
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 $35.15 / $44.50 / $52.40	Professional	TC	$35.15	$44.50	$52.40