Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $48.98 / $70.79	Facility	26	$22.39	$48.98	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $74.13 / $263.03	Professional		$31.62	$74.13	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $41.69 / $100.00	Professional	26	$22.39	$41.69	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $34.67 / $120.23	Professional	TC	$12.88	$34.67	$120.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $87.10 / $89.13	Facility	26	$85.11	$87.10	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $97.72 / $123.03	Professional		$87.10	$97.72	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $57.54 / $70.79	Professional	26	$53.70	$57.54	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $40.74 / $50.12	Professional	TC	$36.31	$40.74	$50.12
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $72.44 / $229.09	Professional		$40.74	$72.44	$229.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $39.81 / $125.89	Professional	26	$24.55	$39.81	$125.89
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $28.84 / $134.90	Professional	TC	$16.22	$28.84	$134.90
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $87.10 / $120.23	Facility	26	$87.10	$87.10	$120.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $95.50 / $389.05	Professional		$51.29	$95.50	$389.05
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $34.67 / $338.84	Professional	26	$25.70	$34.67	$338.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $48.98 / $338.84	Professional	TC	$22.39	$48.98	$338.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $87.10 / $281.84	Professional		$77.62	$87.10	$281.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $53.70 / $97.72	Professional	26	$47.86	$53.70	$97.72
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $36.31 / $186.21	Professional	TC	$30.20	$36.31	$186.21
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $102.33	Professional		$95.50	$95.50	$102.33
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $63.10	Professional	26	$56.23	$56.23	$63.10
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $39.81 / $39.81	Professional	TC	$38.02	$39.81	$39.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $33.88 / $70.79	Professional		$16.98	$33.88	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $72.44 / $107.15	Professional		$48.98	$72.44	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.11 / $53.70	Professional	26	$25.70	$33.11	$53.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $35.48 / $63.10	Professional	TC	$23.44	$35.48	$63.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $75.86 / $89.13	Professional		$60.26	$75.86	$89.13
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $44.67 / $52.48	Professional	26	$35.48	$44.67	$52.48
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $31.62 / $37.15	Professional	TC	$24.55	$31.62	$37.15