Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $20.42 / $22.39 / $22.39	Facility		$20.42	$22.39	$22.39
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.17 / $6.17 / $6.17	Facility	26	$6.17	$6.17	$6.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $25.12 / $47.86	Professional		$10.96	$25.12	$47.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.02 / $5.75 / $19.50	Professional	26	$3.02	$5.75	$19.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $7.08 / $10.00 / $19.95	Professional	TC	$7.08	$10.00	$19.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $30.20 / $61.66	Professional		$11.48	$30.20	$61.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.72 / $7.76 / $15.85	Professional	26	$3.72	$7.76	$15.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $7.76 / $22.39 / $38.90	Professional	TC	$7.76	$22.39	$38.90
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $25.70 / $56.23	Professional		$14.45	$25.70	$56.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.89 / $7.41 / $40.74	Professional	26	$5.89	$7.41	$40.74
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.23 / $15.49 / $25.12	Professional	TC	$10.23	$15.49	$25.12
Medica Facility/Professional Facility Modifier Low / Median / High Price $17.38 / $27.54 / $57.54	Facility		$17.38	$27.54	$57.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $28.84 / $123.03	Professional		$14.45	$28.84	$123.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $4.27 / $9.33 / $87.10	Professional	26	$4.27	$9.33	$87.10
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $20.89 / $97.72	Professional	TC	$10.00	$20.89	$97.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $30.20 / $41.69	Professional		$19.05	$30.20	$41.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $7.94 / $13.49	Professional	26	$5.01	$7.94	$13.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $21.38 / $34.67	Professional	TC	$14.13	$21.38	$34.67
Midlands Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $29.51 / $41.69	Professional		$29.51	$29.51	$41.69
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $8.71 / $15.14	Professional	26	$7.76	$8.71	$15.14
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $20.42 / $34.67	Professional	TC	$20.42	$20.42	$34.67
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $4.79 / $15.49 / $31.62	Professional		$4.79	$15.49	$31.62
United Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $15.85 / $38.02	Professional		$14.45	$15.85	$38.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.37 / $4.68 / $12.30	Professional	26	$4.37	$4.68	$12.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $11.22 / $26.92	Professional	TC	$10.00	$11.22	$26.92
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $38.90	Professional		$28.18	$33.11	$38.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $8.71 / $10.23	Professional	26	$7.41	$8.71	$10.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $24.55 / $28.84	Professional	TC	$20.89	$24.55	$28.84