Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $12.30 / $23.99	Facility	26	$8.91	$12.30	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $257.04	Professional		$52.48	$74.13	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.23 / $38.02	Professional	26	$7.94	$10.23	$38.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	52	$39.81	$39.81	$39.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $52.48 / $117.49	Professional	TC	$42.66	$52.48	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $123.03 / $151.36	Professional		$56.23	$123.03	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $17.78 / $22.39	Professional	26	$9.33	$17.78	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $104.71 / $128.82	Professional	TC	$47.86	$104.71	$128.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $77.62 / $173.78	Professional		$51.29	$77.62	$173.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.88 / $54.95	Professional	26	$8.32	$12.88	$54.95
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $61.66 / $147.91	Professional	TC	$42.66	$61.66	$147.91
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $79.43 / $79.43	Facility	26	$20.42	$79.43	$79.43
Medica Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $104.71 / $371.54	Professional		$57.54	$104.71	$371.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $16.22 / $54.95	Professional	26	$9.33	$16.22	$54.95
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $75.86 / $316.23	Professional	TC	$47.86	$75.86	$316.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $123.03 / $147.91	Professional		$104.71	$123.03	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $19.05 / $22.91	Professional	26	$18.20	$19.05	$22.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $102.33 / $125.89	Professional	TC	$85.11	$102.33	$125.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $104.71 / $147.91	Professional		$89.13	$104.71	$147.91
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $15.14 / $22.91	Professional	26	$15.14	$15.14	$22.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $87.10 / $125.89	Professional	TC	$74.13	$87.10	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $60.26 / $125.89	Professional		$9.77	$60.26	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $83.18 / $138.04	Professional		$57.54	$83.18	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $14.13 / $23.99	Professional	26	$9.12	$14.13	$23.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $69.18 / $114.82	Professional	TC	$47.86	$69.18	$114.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $125.89	Professional		$83.18	$104.71	$125.89
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.22 / $19.50	Professional	26	$12.88	$16.22	$19.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $89.13 / $104.71	Professional	TC	$70.79	$89.13	$104.71