Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $10.96 / $16.98	Facility	26	$10.96	$10.96	$16.98
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $25.12 / $79.43 / $123.03	Facility	TC	$25.12	$79.43	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $44.67 / $213.80	Professional		$33.88	$44.67	$213.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $16.22 / $70.79	Professional	26	$10.96	$16.22	$70.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $28.18 / $79.43	Professional	TC	$21.88	$28.18	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $56.23 / $57.54	Facility	26	$54.95	$56.23	$57.54
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $102.33 / $104.71	Facility	TC	$100.00	$102.33	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $102.33 / $125.89	Professional		$46.77	$102.33	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $29.51 / $36.31	Professional	26	$16.22	$29.51	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $72.44 / $91.20	Professional	TC	$29.51	$72.44	$91.20
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $69.18 / $186.21	Professional		$41.69	$69.18	$186.21
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.50 / $58.88	Professional	26	$12.88	$19.50	$58.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $38.02 / $128.82	Professional	TC	$26.92	$38.02	$128.82
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $70.79 / $70.79	Facility	26	$56.23	$70.79	$70.79
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $102.33 / $134.90 / $134.90	Facility	TC	$102.33	$134.90	$134.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $67.61 / $275.42	Professional		$38.90	$67.61	$275.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $17.38 / $81.28	Professional	26	$13.18	$17.38	$81.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.88 / $194.98	Professional	TC	$24.55	$33.88	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $91.20 / $107.15	Professional		$70.79	$91.20	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $29.51 / $31.62	Professional	26	$25.12	$29.51	$31.62
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $64.57 / $75.86	Professional	TC	$45.71	$64.57	$75.86
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $57.54 / $57.54	Facility	26	$57.54	$57.54	$57.54
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $104.71 / $104.71 / $104.71	Facility	TC	$104.71	$104.71	$104.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $100.00 / $107.15	Professional		$75.86	$100.00	$107.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $29.51 / $30.90	Professional	26	$25.70	$29.51	$30.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $47.86 / $93.33	Professional	TC	$45.71	$47.86	$93.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $30.90 / $70.79	Professional		$12.88	$30.90	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $47.86 / $91.20	Professional		$38.90	$47.86	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.60 / $30.90	Professional	26	$13.18	$16.60	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $31.62 / $60.26	Professional	TC	$24.55	$31.62	$60.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $85.11	Professional		$72.44	$72.44	$85.11
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $25.70	Professional	26	$21.88	$21.88	$25.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $51.29 / $60.26	Professional	TC	$51.29	$51.29	$60.26