Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $12.88 / $81.28	Facility	26	$12.88	$12.88	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $87.10 / $165.96	Professional		$70.79	$87.10	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $14.13 / $38.02	Professional	26	$12.02	$14.13	$38.02
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $51.29 / $52.48	Facility	26	$48.98	$51.29	$52.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $251.19 / $309.03	Professional		$104.71	$251.19	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $34.67 / $43.65	Professional	26	$19.05	$34.67	$43.65
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $204.17	Professional		$89.13	$131.83	$204.17
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.44 / $35.48	Professional	26	$14.13	$23.44	$35.48
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $141.25 / $141.25	Facility	26	$109.65	$141.25	$141.25
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $141.25 / $616.60	Professional		$77.62	$141.25	$616.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $21.88 / $162.18	Professional	26	$15.49	$21.88	$162.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $257.04	Professional		$141.25	$199.53	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $33.88 / $40.74	Professional	26	$30.20	$33.88	$40.74
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $165.96 / $257.04	Professional		$147.91	$165.96	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $33.11 / $37.15	Professional	26	$30.20	$33.11	$37.15
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $102.33 / $194.98	Professional		$75.86	$102.33	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $18.20 / $33.88	Professional	26	$14.79	$18.20	$33.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $177.83 / $208.93	Professional		$177.83	$177.83	$208.93
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $30.20	Professional	26	$25.70	$25.70	$30.20