Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $15.49 / $19.95	Facility	26	$8.91	$15.49	$19.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $48.98 / $338.84	Professional		$21.88	$48.98	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $11.48 / $54.95	Professional	26	$8.91	$11.48	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $25.70 / $218.78	Professional	TC	$12.88	$25.70	$218.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $31.62 / $33.11	Facility	26	$30.90	$31.62	$33.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $60.26 / $151.36	Professional		$35.48	$60.26	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $21.38 / $26.92	Professional	26	$12.30	$21.38	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $38.90 / $138.04	Professional	TC	$22.91	$38.90	$138.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $48.98 / $371.54	Professional		$22.91	$48.98	$371.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $16.60 / $85.11	Professional	26	$8.71	$16.60	$85.11
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $22.39 / $257.04	Professional	TC	$14.45	$22.39	$257.04
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $131.83 / $131.83	Facility	26	$57.54	$131.83	$131.83
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $53.70 / $53.70 / $53.70	Facility	53	$53.70	$53.70	$53.70
Medica Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $54.95 / $758.58	Professional		$23.99	$54.95	$758.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $14.45 / $131.83	Professional	26	$9.77	$14.45	$131.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $26.92 / $707.95	Professional	TC	$12.59	$26.92	$707.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $61.66 / $177.83	Professional		$48.98	$61.66	$177.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $23.99 / $29.51	Professional	26	$19.05	$23.99	$29.51
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $37.15 / $151.36	Professional	TC	$28.18	$37.15	$151.36
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $33.11 / $33.11	Facility	26	$33.11	$33.11	$33.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $60.26 / $177.83	Professional		$45.71	$60.26	$177.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $20.42 / $24.55	Professional	26	$18.20	$20.42	$24.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.02 / $151.36	Professional	TC	$25.70	$38.02	$151.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $20.42 / $43.65	Professional		$9.77	$20.42	$43.65
United Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $33.11 / $107.15	Professional		$22.91	$33.11	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.02 / $24.55	Professional	26	$9.77	$12.02	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $18.62 / $95.50	Professional	TC	$12.59	$18.62	$95.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $43.65 / $51.29	Professional		$43.65	$43.65	$51.29
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $15.85 / $18.62	Professional	26	$15.85	$15.85	$18.62
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $28.18 / $33.11	Professional	TC	$28.18	$28.18	$33.11