Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $24.55 / $69.18	Facility	26	$19.05	$24.55	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $54.95 / $104.71	Professional		$41.69	$54.95	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $15.85 / $34.67	Professional	26	$12.88	$15.85	$34.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $38.02 / $69.18	Professional	TC	$30.20	$38.02	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $102.33 / $134.90	Professional		$67.61	$102.33	$134.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $32.36 / $38.90	Professional	26	$21.88	$32.36	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $69.18 / $95.50	Professional	TC	$45.71	$69.18	$95.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $173.78	Professional		$37.15	$56.23	$173.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $19.05 / $42.66	Professional	26	$12.88	$19.05	$42.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $36.31 / $125.89	Professional	TC	$24.55	$36.31	$125.89
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $79.43 / $79.43	Facility	26	$33.11	$79.43	$79.43
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $102.33 / $537.03	Professional		$57.54	$102.33	$537.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $28.18 / $91.20	Professional	26	$16.60	$28.18	$91.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $63.10 / $218.78	Professional	TC	$38.90	$63.10	$218.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $120.23 / $147.91	Professional		$100.00	$120.23	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $37.15 / $46.77	Professional	26	$30.20	$37.15	$46.77
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $83.18 / $100.00	Professional	TC	$69.18	$83.18	$100.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $134.90	Professional		$104.71	$104.71	$134.90
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $32.36 / $38.90	Professional	26	$32.36	$32.36	$38.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $95.50	Professional	TC	$72.44	$72.44	$95.50
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $38.02 / $79.43	Professional		$13.80	$38.02	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $83.18 / $141.25	Professional		$53.70	$83.18	$141.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.70 / $43.65	Professional	26	$16.60	$25.70	$43.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $57.54 / $97.72	Professional	TC	$37.15	$57.54	$97.72
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $83.18 / $97.72	Professional		$66.07	$83.18	$97.72
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $27.54 / $32.36	Professional	26	$21.88	$27.54	$32.36
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $54.95 / $64.57	Professional	TC	$43.65	$54.95	$64.57