Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $12.59 / $24.55	Facility	26	$10.96	$12.59	$24.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $218.78	Professional		$38.02	$52.48	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.60 / $51.29	Professional	26	$10.00	$16.60	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $36.31 / $123.03	Professional	TC	$26.92	$36.31	$123.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.90 / $40.74	Facility	26	$38.02	$38.90	$40.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $112.20 / $141.25	Professional		$54.95	$112.20	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $28.84 / $35.48	Professional	26	$15.85	$28.84	$35.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $83.18 / $104.71	Professional	TC	$38.90	$83.18	$104.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $69.18 / $158.49	Professional		$41.69	$69.18	$158.49
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $19.05 / $44.67	Professional	26	$11.48	$19.05	$44.67
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $46.77 / $123.03	Professional	TC	$30.90	$46.77	$123.03
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $100.00 / $100.00	Facility	26	$38.90	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $77.62 / $309.03	Professional		$42.66	$77.62	$309.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $19.50 / $95.50	Professional	26	$13.18	$19.50	$95.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $251.19	Professional	TC	$28.18	$40.74	$251.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $100.00 / $117.49	Professional		$87.10	$100.00	$117.49
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $30.90 / $38.90	Professional	26	$25.12	$30.90	$38.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $72.44 / $87.10	Professional	TC	$63.10	$72.44	$87.10
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $40.74 / $40.74	Facility	26	$40.74	$40.74	$40.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $87.10 / $117.49	Professional		$81.28	$87.10	$117.49
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $27.54 / $39.81	Professional	26	$24.55	$27.54	$39.81
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $63.10 / $87.10	Professional	TC	$53.70	$63.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $52.48 / $100.00	Professional		$41.69	$52.48	$100.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.22 / $29.51	Professional	26	$12.88	$16.22	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $36.31 / $69.18	Professional	TC	$28.18	$36.31	$69.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $79.43 / $93.33	Professional		$79.43	$79.43	$93.33
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $20.89 / $25.12	Professional	26	$20.89	$20.89	$25.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $69.18	Professional	TC	$58.88	$58.88	$69.18