Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.83 / $21.88 / $21.88	Facility	26	$11.83	$21.88	$21.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $29.91 / $51.38 / $114.28	Facility	TC	$29.91	$51.38	$114.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $40.27 / $155.62	Professional		$35.22	$40.27	$155.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.10 / $12.57 / $31.70	Professional	26	$11.10	$12.57	$31.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.17 / $27.64 / $56.30	Professional	TC	$23.17	$27.64	$56.30
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.54 / $56.18 / $57.81	Facility	26	$54.54	$56.18	$57.81
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $99.30 / $102.28 / $105.26	Facility	TC	$99.30	$102.28	$105.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $40.72 / $99.29 / $124.11	Professional		$40.72	$99.29	$124.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.74 / $28.70 / $35.88	Professional	26	$12.74	$28.70	$35.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.60 / $70.59 / $88.24	Professional	TC	$25.60	$70.59	$88.24
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $42.10 / $58.25 / $166.55	Professional		$42.10	$58.25	$166.55
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.01 / $18.20 / $58.44	Professional	26	$13.01	$18.20	$58.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.37 / $40.04 / $89.75	Professional	TC	$29.37	$40.04	$89.75
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $56.18 / $70.00 / $70.00	Facility	26	$56.18	$70.00	$70.00
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $102.28 / $136.22 / $136.22	Facility	TC	$102.28	$136.22	$136.22
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.86 / $58.29 / $277.95	Professional		$38.86	$58.29	$277.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.17 / $17.14 / $81.06	Professional	26	$13.17	$17.14	$81.06
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.93 / $33.45 / $196.89	Professional	TC	$24.93	$33.45	$196.89
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $56.18 / $57.81 / $71.64	Facility	26	$56.18	$57.81	$71.64
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $102.28 / $105.26 / $162.72	Facility	TC	$102.28	$105.26	$162.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $71.05 / $91.08 / $142.50	Professional		$71.05	$91.08	$142.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.69 / $38.27 / $70.11	Professional		$12.69	$38.27	$70.11
United Facility/Professional Professional Modifier Low / Median / High Price $38.86 / $48.19 / $80.58	Professional		$38.86	$48.19	$80.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.17 / $16.45 / $27.93	Professional	26	$13.17	$16.45	$27.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.69 / $30.83 / $52.31	Professional	TC	$25.69	$30.83	$52.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $57.75 / $73.09 / $86.00	Professional		$57.75	$73.09	$86.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.14 / $21.70 / $25.50	Professional	26	$17.14	$21.70	$25.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $40.61 / $51.40 / $60.50	Professional	TC	$40.61	$51.40	$60.50