Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.76 / $71.16 / $131.59	Facility	26	$39.76	$71.16	$131.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.91 / $199.53 / $214.85	Professional		$170.91	$199.53	$214.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.89 / $76.11 / $78.31	Facility	26	$73.89	$76.11	$78.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $439.06 / $525.91 / $657.41	Professional		$439.06	$525.91	$657.41
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $190.94 / $268.14 / $382.82	Professional		$190.94	$268.14	$382.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.71 / $33.83 / $64.50	Professional	26	$20.71	$33.83	$64.50
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $76.11 / $297.00 / $297.00	Facility	26	$76.11	$297.00	$297.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $154.19 / $331.41 / $634.75	Professional		$154.19	$331.41	$634.75
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $76.11 / $78.31 / $123.30	Facility	26	$76.11	$78.31	$123.30
Midlands Facility/Professional Professional Modifier Low / Median / High Price $195.63 / $439.06 / $588.49	Professional		$195.63	$439.06	$588.49
United Facility/Professional Professional Modifier Low / Median / High Price $173.46 / $263.14 / $433.46	Professional		$173.46	$263.14	$433.46
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $300.36 / $380.20 / $447.40	Professional		$300.36	$380.20	$447.40