Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $19.05 / $19.95	Facility	26	$7.94	$19.05	$19.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $37.15 / $169.82	Professional		$26.92	$37.15	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $14.79 / $36.31	Professional	26	$7.94	$14.79	$36.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $25.12 / $91.20	Professional	TC	$19.05	$25.12	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $30.90 / $32.36	Facility	26	$30.20	$30.90	$32.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $79.43 / $100.00	Professional		$41.69	$79.43	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $21.38 / $26.92	Professional	26	$11.75	$21.38	$26.92
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $57.54 / $72.44	Professional	TC	$29.51	$57.54	$72.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $50.12 / $114.82	Professional		$30.20	$50.12	$114.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $15.14 / $37.15	Professional	26	$8.71	$15.14	$37.15
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $34.67 / $85.11	Professional	TC	$21.38	$34.67	$85.11
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $100.00 / $100.00	Facility	26	$30.90	$100.00	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $57.54 / $218.78	Professional		$31.62	$57.54	$218.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.79 / $72.44	Professional	26	$10.00	$14.79	$72.44
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.20 / $199.53	Professional	TC	$20.42	$30.20	$199.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $72.44 / $109.65	Professional		$66.07	$72.44	$109.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $22.39 / $31.62	Professional	26	$19.05	$22.39	$31.62
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $51.29 / $77.62	Professional	TC	$45.71	$51.29	$77.62
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Facility	26	$32.36	$32.36	$32.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $66.07 / $83.18	Professional		$57.54	$66.07	$83.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $21.88 / $30.20	Professional	26	$18.62	$21.88	$30.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $46.77 / $61.66	Professional	TC	$36.31	$46.77	$61.66
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $38.02 / $70.79	Professional		$30.20	$38.02	$70.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $12.30 / $22.91	Professional	26	$10.00	$12.30	$22.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $26.30 / $48.98	Professional	TC	$20.42	$26.30	$48.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $67.61	Professional		$57.54	$57.54	$67.61
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $15.85 / $18.62	Professional	26	$15.85	$15.85	$18.62
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $40.74 / $47.86	Professional	TC	$40.74	$40.74	$47.86