Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $45.71 / $45.71	Facility		$45.71	$45.71	$45.71
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $9.77 / $9.77	Facility	26	$9.77	$9.77	$9.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $52.48 / $120.23	Professional		$22.91	$52.48	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.01 / $16.22 / $43.65	Professional	26	$5.01	$16.22	$43.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $21.88 / $46.77	Professional	TC	$15.14	$21.88	$46.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $61.66 / $120.23	Professional		$25.12	$61.66	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.62 / $12.30 / $26.92	Professional	26	$5.62	$12.30	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $48.98 / $81.28	Professional	TC	$19.95	$48.98	$81.28
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $51.29 / $147.91	Professional		$28.84	$51.29	$147.91
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.30 / $123.03	Professional	26	$8.91	$12.30	$123.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $35.48 / $58.88	Professional	TC	$22.91	$35.48	$58.88
Medica Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $61.66 / $125.89	Facility		$36.31	$61.66	$125.89
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 $28.84 / $58.88 / $263.03	Professional		$28.84	$58.88	$263.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $14.79 / $144.54	Professional	26	$6.46	$14.79	$144.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $44.67 / $223.87	Professional	TC	$21.88	$44.67	$223.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $61.66 / $91.20	Professional		$38.02	$61.66	$91.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $12.30 / $20.89	Professional	26	$7.76	$12.30	$20.89
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $48.98 / $79.43	Professional	TC	$30.20	$48.98	$79.43
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $91.20	Professional		$57.54	$57.54	$91.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $13.49 / $26.92	Professional	26	$13.18	$13.49	$26.92
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $43.65 / $79.43	Professional	TC	$43.65	$43.65	$79.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $7.08 / $30.20 / $61.66	Professional		$7.08	$30.20	$61.66
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $31.62 / $79.43	Professional		$28.84	$31.62	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $7.24 / $19.50	Professional	26	$6.76	$7.24	$19.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $23.99 / $58.88	Professional	TC	$21.88	$23.99	$58.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $66.07 / $77.62	Professional		$56.23	$66.07	$77.62
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $13.49 / $15.85	Professional	26	$11.22	$13.49	$15.85
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $53.70 / $63.10	Professional	TC	$45.71	$53.70	$63.10