Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $223.87 / $229.09	Facility	26	$112.20	$223.87	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $660.69 / $3,235.94	Professional		$426.58	$660.69	$3,235.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $177.83 / $549.54	Professional	26	$107.15	$177.83	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $426.58 / $1,047.13	Professional	TC	$302.00	$426.58	$1,047.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $331.13 / $346.74 / $354.81	Facility	26	$331.13	$346.74	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,148.15 / $1,513.56	Professional		$645.65	$1,148.15	$1,513.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $251.19 / $309.03	Professional	26	$138.04	$251.19	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $912.01 / $1,202.26	Professional	TC	$549.54	$912.01	$1,202.26
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $812.83 / $2,818.38	Professional		$426.58	$812.83	$2,818.38
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $177.83 / $549.54	Professional	26	$100.00	$177.83	$549.54
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $616.60 / $2,398.83	Professional	TC	$331.13	$616.60	$2,398.83
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $1,000.00 / $1,000.00	Facility	26	$776.25	$1,000.00	$1,000.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $1,047.13 / $6,025.60	Professional		$616.60	$1,047.13	$6,025.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $181.97 / $933.25	Professional	26	$109.65	$181.97	$933.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $794.33 / $5,370.32	Professional	TC	$446.68	$794.33	$5,370.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,288.25 / $1,513.56	Professional		$933.25	$1,288.25	$1,513.56
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $257.04 / $331.13	Professional	26	$213.80	$257.04	$331.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $1,047.13 / $1,202.26	Professional	TC	$724.44	$1,047.13	$1,202.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,122.02 / $1,513.56	Professional		$1,047.13	$1,122.02	$1,513.56
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $234.42 / $323.59	Professional	26	$194.98	$234.42	$323.59
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $812.83 / $870.96 / $1,202.26	Professional	TC	$812.83	$870.96	$1,202.26
United Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $851.14 / $1,621.81	Professional		$562.34	$851.14	$1,621.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $154.88 / $331.13	Professional	26	$109.65	$154.88	$331.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $676.08 / $1,318.26	Professional	TC	$446.68	$676.08	$1,318.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,258.93	Professional		$1,071.52	$1,071.52	$1,258.93
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $239.88 / $281.84	Professional	26	$239.88	$239.88	$281.84
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $831.76 / $977.24	Professional	TC	$831.76	$831.76	$977.24