Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.78 / $25.12 / $48.98	Facility	26	$17.78	$25.12	$48.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $120.23 / $467.74	Professional		$57.54	$120.23	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $24.55 / $120.23	Professional	26	$16.22	$24.55	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $45.71 / $104.71	Professional	TC	$36.31	$45.71	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $128.82 / $162.18	Professional		$95.50	$128.82	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $39.81 / $47.86	Professional	26	$30.90	$39.81	$47.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $91.20 / $114.82	Professional	TC	$64.57	$91.20	$114.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $81.28 / $245.47	Professional		$52.48	$81.28	$245.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.12 / $158.49	Professional	26	$16.60	$25.12	$158.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $50.12 / $134.90	Professional	TC	$35.48	$50.12	$134.90
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $81.28 / $81.28	Facility	26	$81.28	$81.28	$81.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $120.23 / $416.87	Professional		$67.61	$120.23	$416.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $38.02 / $114.82	Professional	26	$20.89	$38.02	$114.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $79.43 / $302.00	Professional	TC	$44.67	$79.43	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $141.25 / $162.18	Professional		$117.49	$141.25	$162.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $44.67 / $46.77	Professional	26	$37.15	$44.67	$46.77
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $95.50 / $117.49	Professional	TC	$79.43	$95.50	$117.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $114.82 / $162.18	Professional		$102.33	$114.82	$162.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $38.90 / $48.98	Professional	26	$32.36	$38.90	$48.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $75.86 / $117.49	Professional	TC	$70.79	$75.86	$117.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $60.26 / $128.82	Professional		$19.05	$60.26	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $102.33 / $165.96	Professional		$64.57	$102.33	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $31.62 / $51.29	Professional	26	$20.42	$31.62	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $69.18 / $112.20	Professional	TC	$44.67	$69.18	$112.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $141.25	Professional		$120.23	$120.23	$141.25
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $42.66	Professional	26	$36.31	$36.31	$42.66
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $83.18 / $97.72	Professional	TC	$83.18	$83.18	$97.72