Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $117.49 / $147.91	Facility	26	$72.44	$117.49	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $446.68 / $1,778.28	Professional		$275.42	$446.68	$1,778.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $125.89 / $407.38	Professional	26	$70.79	$125.89	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $302.00 / $630.96	Professional	TC	$199.53	$302.00	$630.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $223.87 / $229.09	Facility	26	$218.78	$223.87	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $645.65 / $870.96	Professional		$389.05	$645.65	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $162.18 / $199.53	Professional	26	$91.20	$162.18	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $489.78 / $660.69	Professional	TC	$288.40	$489.78	$660.69
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $457.09 / $1,698.24	Professional		$239.88	$457.09	$1,698.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $114.82 / $371.54	Professional	26	$64.57	$114.82	$371.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $338.84 / $1,380.38	Professional	TC	$173.78	$338.84	$1,380.38
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $660.69 / $660.69	Facility	26	$501.19	$660.69	$660.69
Medica Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $575.44 / $2,884.03	Professional		$346.74	$575.44	$2,884.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $109.65 / $549.54	Professional	26	$72.44	$109.65	$549.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $407.38 / $2,511.89	Professional	TC	$234.42	$407.38	$2,511.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $812.83 / $870.96	Professional		$524.81	$812.83	$870.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $162.18 / $218.78	Professional	26	$141.25	$162.18	$218.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $630.96 / $707.95	Professional	TC	$389.05	$630.96	$707.95
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $630.96 / $870.96	Professional		$575.44	$630.96	$870.96
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $151.36 / $213.80	Professional	26	$125.89	$151.36	$213.80
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $426.58 / $457.09 / $707.95	Professional	TC	$426.58	$457.09	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $457.09 / $912.01	Professional		$309.03	$457.09	$912.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $100.00 / $213.80	Professional	26	$72.44	$100.00	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $363.08 / $691.83	Professional	TC	$234.42	$363.08	$691.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $588.84 / $691.83	Professional		$588.84	$588.84	$691.83
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $154.88 / $181.97	Professional	26	$154.88	$154.88	$181.97
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $436.52 / $436.52 / $512.86	Professional	TC	$436.52	$436.52	$512.86