Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $29.51 / $29.51	Facility		$29.51	$29.51	$29.51
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $17.78 / $17.78	Facility	26	$17.78	$17.78	$17.78
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $11.48 / $11.48 / $14.45	Facility	TC	$11.48	$11.48	$14.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $29.51 / $93.33	Professional		$14.13	$29.51	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $20.89 / $79.43	Professional	26	$8.91	$20.89	$79.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $5.01 / $7.08 / $52.48	Professional	TC	$5.01	$7.08	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $35.48 / $52.48	Professional		$12.88	$35.48	$52.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $21.88 / $30.90	Professional	26	$10.00	$21.88	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3.72 / $13.80 / $19.95	Professional	TC	$3.72	$13.80	$19.95
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $30.90 / $70.79	Professional		$20.42	$30.90	$70.79
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.50 / $61.66	Professional	26	$15.85	$19.50	$61.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $6.31 / $10.96 / $61.66	Professional	TC	$6.31	$10.96	$61.66
Medica Facility/Professional Facility Modifier Low / Median / High Price $22.91 / $33.88 / $60.26	Facility		$22.91	$33.88	$60.26
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 $19.05 / $35.48 / $131.83	Professional		$19.05	$35.48	$131.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $25.12 / $95.50	Professional	26	$12.02	$25.12	$95.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $6.61 / $15.14 / $95.50	Professional	TC	$6.61	$15.14	$95.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $35.48 / $52.48	Professional		$14.13	$35.48	$52.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $23.99 / $45.71	Professional	26	$20.89	$23.99	$45.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $9.33 / $14.45 / $18.20	Professional	TC	$9.33	$14.45	$18.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $40.74 / $40.74	Professional		$28.18	$40.74	$40.74
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $24.55 / $24.55	Professional	26	$17.78	$24.55	$24.55
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $15.85 / $15.85	Professional	TC	$10.00	$15.85	$15.85
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $8.91 / $19.50 / $38.90	Professional		$8.91	$19.50	$38.90
United Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $21.88 / $54.95	Professional		$20.42	$21.88	$54.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $12.88 / $34.67	Professional	26	$12.30	$12.88	$34.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $7.94 / $8.71 / $19.95	Professional	TC	$7.94	$8.71	$19.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $40.74 / $47.86	Professional		$34.67	$40.74	$47.86
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $23.99 / $28.18	Professional	26	$20.42	$23.99	$28.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $16.60 / $19.50	Professional	TC	$14.13	$16.60	$19.50