Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $38.02 / $61.66	Facility	26	$25.12	$38.02	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $67.61 / $257.04	Professional		$45.71	$67.61	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $50.12 / $114.82	Professional	26	$26.30	$50.12	$114.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.38 / $56.23 / $229.09	Professional	52	$21.38	$56.23	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $37.15 / $134.90	Professional	TC	$19.95	$37.15	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $100.00 / $102.33	Facility	26	$95.50	$100.00	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $125.89 / $154.88	Professional		$66.07	$125.89	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $66.07 / $83.18	Professional	26	$36.31	$66.07	$83.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $57.54 / $72.44	Professional	TC	$30.20	$57.54	$72.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $79.43 / $162.18	Professional		$52.48	$79.43	$162.18
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $43.65 / $89.13	Professional	26	$28.84	$43.65	$89.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $35.48 / $93.33	Professional	TC	$23.44	$35.48	$93.33
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $128.82 / $128.82	Facility	26	$100.00	$128.82	$128.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $102.33 / $331.13	Professional		$57.54	$102.33	$331.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $45.71 / $181.97	Professional	26	$30.90	$45.71	$181.97
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $151.36	Professional	TC	$23.44	$31.62	$151.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $123.03 / $181.97	Professional		$102.33	$123.03	$181.97
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $69.18 / $100.00	Professional	26	$56.23	$69.18	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $54.95 / $83.18	Professional	TC	$46.77	$54.95	$83.18
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Facility	26	$102.33	$102.33	$102.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $123.03 / $181.97	Professional		$109.65	$123.03	$181.97
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $66.07 / $100.00	Professional	26	$61.66	$66.07	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $56.23 / $93.33	Professional	TC	$46.77	$56.23	$93.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $45.71 / $89.13	Professional		$22.91	$45.71	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $67.61 / $123.03	Professional		$52.48	$67.61	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $38.02 / $69.18	Professional	26	$29.51	$38.02	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $29.51 / $54.95	Professional	TC	$23.44	$29.51	$54.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $114.82	Professional		$97.72	$97.72	$114.82
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $52.48 / $61.66	Professional	26	$52.48	$52.48	$61.66
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $52.48	Professional	TC	$44.67	$44.67	$52.48