Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $549.54 / $588.84	Facility		$93.33	$549.54	$588.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $53.70	Facility	26	$53.70	$53.70	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $107.15 / $436.52	Professional		$44.67	$107.15	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $57.54 / $194.98	Professional	26	$30.90	$57.54	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.90 / $165.96	Professional	TC	$25.12	$38.90	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $169.82 / $269.15	Professional		$141.25	$169.82	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $91.20 / $112.20	Professional	26	$77.62	$91.20	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $72.44 / $104.71	Professional	TC	$60.26	$72.44	$104.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $117.49 / $588.84	Professional		$60.26	$117.49	$588.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $85.11 / $309.03	Professional	26	$35.48	$85.11	$309.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $48.98 / $363.08	Professional	TC	$23.44	$48.98	$363.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $269.15 / $1,380.38	Facility		$77.62	$269.15	$1,380.38
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $323.59 / $323.59 / $323.59	Facility	26	$323.59	$323.59	$323.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $199.53 / $1,318.26	Professional		$87.10	$199.53	$1,318.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $107.15 / $630.96	Professional	26	$44.67	$107.15	$630.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $89.13 / $870.96	Professional	TC	$32.36	$89.13	$870.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $169.82 / $407.38	Professional		$141.25	$169.82	$407.38
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $97.72 / $151.36	Professional	26	$79.43	$97.72	$151.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $72.44 / $257.04	Professional	TC	$60.26	$72.44	$257.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $169.82 / $371.54	Professional		$138.04	$169.82	$371.54
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $97.72 / $144.54	Professional	26	$77.62	$97.72	$144.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $72.44 / $229.09	Professional	TC	$60.26	$72.44	$229.09
United Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $1,202.26 / $2,344.23	Facility		$281.84	$1,202.26	$2,344.23
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $154.88 / $354.81	Professional		$70.79	$154.88	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $89.13 / $147.91	Professional	26	$40.74	$89.13	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $64.57 / $213.80	Professional	TC	$29.51	$64.57	$213.80
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $144.54	Professional		$123.03	$123.03	$144.54
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $70.79 / $83.18	Professional	26	$70.79	$70.79	$83.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $63.10	Professional	TC	$53.70	$53.70	$63.10