Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $28.18 / $186.21	Facility	26	$28.18	$28.18	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $81.28 / $316.23	Professional		$63.10	$81.28	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $30.90 / $154.88	Professional	26	$25.70	$30.90	$154.88
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $144.54 / $204.17 / $741.31	Professional	50	$144.54	$204.17	$741.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $43.65 / $85.11	Professional	TC	$33.88	$43.65	$85.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $109.65 / $112.20	Facility	26	$104.71	$109.65	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $177.83 / $223.87	Professional		$102.33	$177.83	$223.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $75.86 / $95.50	Professional	26	$38.02	$75.86	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $102.33 / $134.90	Professional	TC	$60.26	$102.33	$134.90
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $151.36 / $223.87	Professional		$74.13	$151.36	$223.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $60.26 / $81.28	Professional	26	$31.62	$60.26	$81.28
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $81.28 / $141.25	Professional	TC	$38.02	$81.28	$141.25
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $144.54 / $144.54	Facility	26	$109.65	$144.54	$144.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $154.88 / $588.84	Professional		$83.18	$154.88	$588.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $338.84	Professional	26	$33.11	$45.71	$338.84
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $75.86 / $354.81	Professional	TC	$50.12	$75.86	$354.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $173.78 / $234.42	Professional		$147.91	$173.78	$234.42
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $72.44 / $97.72	Professional	26	$64.57	$72.44	$97.72
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $100.00 / $138.04	Professional	TC	$83.18	$100.00	$138.04
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $194.98 / $208.93	Professional		$173.78	$194.98	$208.93
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $75.86 / $85.11	Professional	26	$70.79	$75.86	$85.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $123.03 / $125.89	Professional	TC	$100.00	$123.03	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $107.15 / $204.17	Professional		$81.28	$107.15	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $41.69 / $77.62	Professional	26	$33.11	$41.69	$77.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $67.61 / $128.82	Professional	TC	$50.12	$67.61	$128.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $131.83 / $154.88	Professional		$131.83	$131.83	$154.88
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $57.54 / $67.61	Professional	26	$57.54	$57.54	$67.61
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $89.13	Professional	TC	$75.86	$75.86	$89.13