Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.32 / $44.32 / $140.44	Facility		$44.32	$44.32	$140.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.36 / $9.36 / $9.36	Facility	26	$9.36	$9.36	$9.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.33 / $30.86 / $62.57	Professional		$23.33	$30.86	$62.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $4.93 / $6.08 / $25.01	Professional	26	$4.93	$6.08	$25.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.39 / $21.89 / $50.00	Professional	TC	$18.39	$21.89	$50.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.36 / $62.29 / $119.61	Professional		$25.36	$62.29	$119.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.59 / $12.44 / $27.14	Professional	26	$5.59	$12.44	$27.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.77 / $48.89 / $79.73	Professional	TC	$19.77	$48.89	$79.73
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $51.80 / $106.13	Professional		$25.00	$51.80	$106.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $6.86 / $11.61 / $48.18	Professional	26	$6.86	$11.61	$48.18
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.93 / $36.74 / $71.37	Professional	TC	$10.93	$36.74	$71.37
Medica Facility/Professional Facility Modifier Low / Median / High Price $35.93 / $62.29 / $125.11	Facility		$35.93	$62.29	$125.11
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 $28.57 / $57.04 / $263.07	Professional		$28.57	$57.04	$263.07
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $11.50 / $145.30	Professional	26	$6.46	$11.50	$145.30
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.76 / $43.52 / $226.21	Professional	TC	$21.76	$43.52	$226.21
Midlands Facility/Professional Facility Modifier Low / Median / High Price $35.50 / $58.23 / $85.00	Facility		$35.50	$58.23	$85.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $49.31 / $49.31 / $49.31	Facility	26	$49.31	$49.31	$49.31
Midlands Facility/Professional Professional Modifier Low / Median / High Price $37.28 / $58.23 / $85.00	Professional		$37.28	$58.23	$85.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $6.87 / $30.17 / $55.48	Professional		$6.87	$30.17	$55.48
United Facility/Professional Professional Modifier Low / Median / High Price $28.57 / $30.30 / $66.88	Professional		$28.57	$30.30	$66.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.76 / $7.02 / $22.30	Professional	26	$6.76	$7.02	$22.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.75 / $22.41 / $50.94	Professional	TC	$21.75	$22.41	$50.94
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $56.70 / $66.80 / $78.50	Professional		$56.70	$66.80	$78.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $11.30 / $13.40 / $15.70	Professional	26	$11.30	$13.40	$15.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $45.40 / $53.40 / $62.80	Professional	TC	$45.40	$53.40	$62.80