Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $70.79	Facility	26	$45.71	$45.71	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $199.53 / $724.44	Professional		$173.78	$199.53	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $194.98	Professional	26	$41.69	$51.29	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $151.36 / $316.23	Professional	TC	$125.89	$151.36	$316.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $154.88 / $162.18 / $165.96	Facility	26	$154.88	$162.18	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $489.78 / $602.56	Professional		$275.42	$489.78	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $120.23 / $151.36	Professional	26	$66.07	$120.23	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $363.08 / $457.09	Professional	TC	$199.53	$363.08	$457.09
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $331.13 / $1,202.26	Professional		$199.53	$331.13	$1,202.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $70.79 / $275.42	Professional	26	$47.86	$70.79	$275.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $194.98 / $724.44	Professional	TC	$134.90	$194.98	$724.44
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $234.42 / $234.42	Facility	26	$123.03	$234.42	$234.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $389.05 / $1,380.38	Professional		$223.87	$389.05	$1,380.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $331.13	Professional	26	$54.95	$81.28	$331.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $245.47 / $1,047.13	Professional	TC	$165.96	$245.47	$1,047.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $489.78 / $645.65	Professional		$407.38	$489.78	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $158.49	Professional	26	$102.33	$120.23	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $371.54 / $489.78	Professional	TC	$302.00	$371.54	$489.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	26	$165.96	$165.96	$165.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $478.63 / $891.25	Professional		$407.38	$478.63	$891.25
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $120.23 / $218.78	Professional	26	$104.71	$120.23	$218.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $354.81 / $676.08	Professional	TC	$302.00	$354.81	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $302.00 / $676.08	Professional		$223.87	$302.00	$676.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $75.86 / $162.18	Professional	26	$54.95	$75.86	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $229.09 / $512.86	Professional	TC	$165.96	$229.09	$512.86
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $537.03	Professional		$457.09	$457.09	$537.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $134.90	Professional	26	$114.82	$114.82	$134.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $398.11	Professional	TC	$338.84	$338.84	$398.11