Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $26.30 / $31.62	Facility	26	$12.88	$26.30	$31.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $53.70 / $144.54	Professional		$34.67	$53.70	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $15.49 / $57.54	Professional	26	$10.00	$15.49	$57.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $31.62 / $134.90	Professional	TC	$21.88	$31.62	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $27.54 / $28.18	Facility	26	$26.30	$27.54	$28.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $102.33 / $138.04	Professional		$58.88	$102.33	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $33.88 / $42.66	Professional	26	$11.48	$33.88	$42.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $70.79 / $95.50	Professional	TC	$45.71	$70.79	$95.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $70.79 / $275.42	Professional		$38.90	$70.79	$275.42
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $19.50 / $79.43	Professional	26	$13.80	$19.50	$79.43
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $47.86 / $190.55	Professional	TC	$25.12	$47.86	$190.55
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $100.00 / $100.00	Facility	26	$34.67	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $91.20 / $478.63	Professional		$44.67	$91.20	$478.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $19.50 / $213.80	Professional	26	$9.12	$19.50	$213.80
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $51.29 / $426.58	Professional	TC	$26.30	$51.29	$426.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $109.65 / $147.91	Professional		$83.18	$109.65	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $32.36 / $45.71	Professional	26	$17.78	$32.36	$45.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $70.79 / $128.82	Professional	TC	$53.70	$70.79	$128.82
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $28.18 / $28.18	Facility	26	$28.18	$28.18	$28.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $100.00 / $147.91	Professional		$91.20	$100.00	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $23.99 / $38.02	Professional	26	$16.60	$23.99	$38.02
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $74.13 / $128.82	Professional	TC	$66.07	$74.13	$128.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $33.88 / $75.86	Professional		$16.22	$33.88	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $58.88 / $95.50	Professional		$40.74	$58.88	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $17.78 / $30.90	Professional	26	$9.12	$17.78	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.02 / $81.28	Professional	TC	$25.12	$38.02	$81.28
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $87.10	Professional		$74.13	$74.13	$87.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $30.20	Professional	26	$25.70	$25.70	$30.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $47.86 / $56.23	Professional	TC	$47.86	$47.86	$56.23