Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $30.90 / $67.61	Facility	26	$26.30	$30.90	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $75.86 / $269.15	Professional		$32.36	$75.86	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $50.12 / $158.49	Professional	26	$19.05	$50.12	$158.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $36.31 / $234.42 / $562.34	Professional	50	$36.31	$234.42	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $8.91 / $28.18 / $114.82	Professional	TC	$8.91	$28.18	$114.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $74.13 / $77.62	Facility	26	$72.44	$74.13	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $151.36 / $190.55	Professional		$38.90	$151.36	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $75.86 / $95.50	Professional	26	$23.44	$75.86	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $75.86 / $95.50	Professional	TC	$12.30	$75.86	$95.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $95.50 / $151.36	Professional		$58.88	$95.50	$151.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $57.54 / $120.23	Professional	26	$30.90	$57.54	$120.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $45.71 / $120.23	Professional	TC	$26.92	$45.71	$120.23
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $147.91 / $147.91	Facility	26	$77.62	$147.91	$147.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $70.79 / $363.08	Professional		$32.36	$70.79	$363.08
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $30.90 / $199.53	Professional	26	$21.38	$30.90	$199.53
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $33.11 / $213.80	Professional	TC	$10.00	$33.11	$213.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $128.82 / $141.25	Professional		$107.15	$128.82	$141.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $66.07 / $112.20	Professional	26	$50.12	$66.07	$112.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $58.88 / $70.79	Professional	TC	$23.99	$58.88	$70.79
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $77.62	Facility	26	$77.62	$77.62	$77.62
Midlands Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $141.25 / $151.36	Professional		$69.18	$141.25	$151.36
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $61.66 / $83.18	Professional	26	$46.77	$61.66	$83.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $74.13 / $89.13	Professional	TC	$22.91	$74.13	$89.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $58.88 / $112.20	Professional		$30.90	$58.88	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $61.66 / $107.15	Professional		$32.36	$61.66	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $28.84 / $60.26	Professional	26	$21.38	$28.84	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $33.11 / $60.26	Professional	TC	$10.23	$33.11	$60.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $134.90	Professional		$114.82	$114.82	$134.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $69.18	Professional	26	$57.54	$57.54	$69.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $56.23 / $66.07	Professional	TC	$56.23	$56.23	$66.07