Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $12.88 / $77.62	Facility	26	$12.88	$12.88	$77.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $53.70 / $158.49	Professional		$41.69	$53.70	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $14.13 / $77.62	Professional	26	$11.75	$14.13	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.02 / $112.20	Professional	TC	$28.84	$38.02	$112.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $50.12 / $51.29	Facility	26	$48.98	$50.12	$51.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $128.82 / $162.18	Professional		$64.57	$128.82	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $32.36 / $40.74	Professional	26	$17.78	$32.36	$40.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $97.72 / $120.23	Professional	TC	$45.71	$97.72	$120.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $81.28 / $302.00	Professional		$52.48	$81.28	$302.00
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $21.38 / $93.33	Professional	26	$14.45	$21.38	$93.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $50.12 / $223.87	Professional	TC	$35.48	$50.12	$223.87
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $70.79 / $70.79	Facility	26	$50.12	$70.79	$70.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $95.50 / $323.59	Professional		$42.66	$95.50	$323.59
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $18.62 / $91.20	Professional	26	$12.30	$18.62	$91.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $45.71 / $234.42	Professional	TC	$30.20	$45.71	$234.42
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $117.49 / $134.90	Professional		$104.71	$117.49	$134.90
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $33.11 / $37.15	Professional	26	$28.84	$33.11	$37.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $85.11 / $97.72	Professional	TC	$74.13	$85.11	$97.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $134.90	Professional		$109.65	$125.89	$134.90
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $33.11 / $37.15	Professional	26	$31.62	$33.11	$37.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $93.33 / $97.72	Professional	TC	$77.62	$93.33	$97.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $41.69 / $93.33	Professional		$15.14	$41.69	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $60.26 / $151.36	Professional		$42.66	$60.26	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $17.38 / $44.67	Professional	26	$12.30	$17.38	$44.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $42.66 / $107.15	Professional	TC	$30.20	$42.66	$107.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $117.49	Professional		$100.00	$100.00	$117.49
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 $74.13 / $74.13 / $87.10	Professional	TC	$74.13	$74.13	$87.10