Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $154.88 / $812.83	Facility		$41.69	$154.88	$812.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $26.92 / $269.15	Facility	26	$26.92	$26.92	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $91.20 / $208.93	Professional		$41.69	$91.20	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $47.86 / $194.98	Professional	26	$25.70	$47.86	$194.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $147.91 / $645.65	Professional	50	$83.18	$147.91	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.13 / $19.05 / $64.57	Professional	TC	$14.13	$19.05	$64.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $295.12 / $302.00	Facility		$281.84	$295.12	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $165.96 / $169.82	Facility	26	$162.18	$165.96	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $154.88	Professional		$77.62	$114.82	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $70.79 / $93.33	Professional	26	$40.74	$70.79	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $44.67 / $83.18	Professional	TC	$32.36	$44.67	$83.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $177.83 / $281.84	Professional		$47.86	$177.83	$281.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $87.10 / $165.96	Professional	26	$29.51	$87.10	$165.96
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $67.61 / $141.25	Professional	TC	$15.85	$67.61	$141.25
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $154.88 / $338.84	Facility		$45.71	$154.88	$338.84
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $199.53 / $199.53	Facility	26	$165.96	$199.53	$199.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $107.15 / $660.69	Professional		$54.95	$107.15	$660.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $52.48 / $338.84	Professional	26	$32.36	$52.48	$338.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $39.81 / $407.38	Professional	TC	$21.38	$39.81	$407.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $120.23 / $199.53	Professional		$95.50	$120.23	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $77.62 / $107.15	Professional	26	$61.66	$77.62	$107.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $44.67 / $93.33	Professional	TC	$34.67	$44.67	$93.33
Midlands Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $302.00	Facility		$302.00	$302.00	$302.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $169.82 / $169.82	Facility	26	$169.82	$169.82	$169.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $128.82 / $199.53	Professional		$109.65	$128.82	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $81.28 / $107.15	Professional	26	$69.18	$81.28	$107.15
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $48.98 / $93.33	Professional	TC	$39.81	$48.98	$93.33
United Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $239.88 / $323.59	Facility		$151.36	$239.88	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $81.28 / $131.83	Professional		$52.48	$81.28	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $46.77 / $79.43	Professional	26	$32.36	$46.77	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $32.36 / $64.57	Professional	TC	$20.42	$32.36	$64.57
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $100.00	Professional		$85.11	$85.11	$100.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $53.70 / $63.10	Professional	26	$53.70	$53.70	$63.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $31.62 / $37.15	Professional	TC	$31.62	$31.62	$37.15