Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $27.97 / $27.97 / $28.12	Facility		$27.97	$27.97	$28.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.07 / $17.07 / $17.07	Facility	26	$17.07	$17.07	$17.07
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $11.03 / $54.78 / $87.03	Facility	TC	$11.03	$54.78	$87.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.80 / $19.22 / $77.34	Professional		$14.80	$19.22	$77.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.99 / $10.66 / $24.30	Professional	26	$8.99	$10.66	$24.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $5.81 / $7.01 / $15.33	Professional	TC	$5.81	$7.01	$15.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $12.90 / $35.40 / $52.85	Professional		$12.90	$35.40	$52.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.91 / $22.00 / $31.23	Professional	26	$9.91	$22.00	$31.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.72 / $13.84 / $19.98	Professional	TC	$3.72	$13.84	$19.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $20.34 / $29.94 / $58.10	Professional		$20.34	$29.94	$58.10
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.29 / $19.53 / $41.19	Professional	26	$12.29	$19.53	$41.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $4.45 / $10.54 / $29.19	Professional	TC	$4.45	$10.54	$29.19
Medica Facility/Professional Facility Modifier Low / Median / High Price $22.79 / $33.76 / $60.40	Facility		$22.79	$33.76	$60.40
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 Facility Modifier TC Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	TC	$100.00	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $19.22 / $34.36 / $130.47	Professional		$19.22	$34.36	$130.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.04 / $22.35 / $95.76	Professional	26	$12.04	$22.35	$95.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $7.55 / $13.02 / $95.76	Professional	TC	$7.55	$13.02	$95.76
Midlands Facility/Professional Facility Modifier Low / Median / High Price $23.60 / $34.49 / $46.27	Facility		$23.60	$34.49	$46.27
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $32.08 / $32.08 / $32.08	Facility	26	$32.08	$32.08	$32.08
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $19.13 / $19.13 / $19.13	Facility	TC	$19.13	$19.13	$19.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $23.60 / $35.51 / $49.91	Professional		$23.60	$35.51	$49.91
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.64 / $19.09 / $34.90	Professional		$8.64	$19.09	$34.90
United Facility/Professional Professional Modifier Low / Median / High Price $20.34 / $21.03 / $47.80	Professional		$20.34	$21.03	$47.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.04 / $12.79 / $29.08	Professional	26	$12.04	$12.79	$29.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $7.97 / $8.24 / $17.59	Professional	TC	$7.97	$8.24	$17.59
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $34.60 / $40.70 / $47.90	Professional		$34.60	$40.70	$47.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.39 / $24.00 / $28.30	Professional	26	$20.39	$24.00	$28.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $14.20 / $16.70 / $19.60	Professional	TC	$14.20	$16.70	$19.60