Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $35.48 / $100.00	Facility	26	$28.18	$35.48	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $61.66 / $173.78	Professional		$37.15	$61.66	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $23.99 / $93.33	Professional	26	$18.62	$23.99	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $34.67 / $89.13	Professional	TC	$18.20	$34.67	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $120.23 / $151.36	Professional		$72.44	$120.23	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $43.65 / $54.95	Professional	26	$30.20	$43.65	$54.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $77.62 / $97.72	Professional	TC	$34.67	$77.62	$97.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $72.44 / $134.90	Professional		$50.12	$72.44	$134.90
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $27.54 / $54.95	Professional	26	$19.05	$27.54	$54.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.65 / $79.43	Professional	TC	$30.90	$43.65	$79.43
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $97.72 / $97.72	Facility	26	$47.86	$97.72	$97.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $85.11 / $380.19	Professional		$48.98	$85.11	$380.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $39.81 / $128.82	Professional	26	$22.91	$39.81	$128.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $40.74 / $239.88	Professional	TC	$21.38	$40.74	$239.88
Midlands Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $104.71 / $147.91	Professional		$85.11	$104.71	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $50.12 / $61.66	Professional	26	$41.69	$50.12	$61.66
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $43.65 / $95.50	Professional	TC	$41.69	$43.65	$95.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $74.13 / $144.54	Professional		$74.13	$74.13	$144.54
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $54.95	Professional	26	$43.65	$43.65	$54.95
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $30.20 / $91.20	Professional	TC	$30.20	$30.20	$91.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $52.48 / $109.65	Professional		$20.89	$52.48	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $74.13 / $125.89	Professional		$47.86	$74.13	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $36.31 / $60.26	Professional	26	$22.91	$36.31	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $38.90 / $67.61	Professional	TC	$21.88	$38.90	$67.61
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $109.65 / $128.82	Professional		$87.10	$109.65	$128.82
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $39.81 / $46.77	Professional	26	$31.62	$39.81	$46.77
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $70.79 / $83.18	Professional	TC	$56.23	$70.79	$83.18