Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $25.70 / $158.49	Facility	26	$25.70	$25.70	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $190.55	Professional		$54.95	$70.79	$190.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $28.84 / $104.71	Professional	26	$22.91	$28.84	$104.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $223.87 / $489.78	Professional	50	$66.07	$223.87	$489.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $91.20 / $91.20 / $91.20	Professional	52	$91.20	$91.20	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $72.44	Professional	TC	$28.84	$38.90	$72.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $95.50 / $100.00	Facility	26	$93.33	$95.50	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $162.18 / $204.17	Professional		$87.10	$162.18	$204.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $70.79 / $89.13	Professional	26	$30.90	$70.79	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $91.20 / $114.82	Professional	TC	$53.70	$91.20	$114.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $147.91 / $245.47	Professional		$64.57	$147.91	$245.47
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $53.70 / $114.82	Professional	26	$29.51	$53.70	$114.82
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $74.13 / $144.54	Professional	TC	$34.67	$74.13	$144.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $134.90 / $134.90	Facility	26	$95.50	$134.90	$134.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $120.23 / $501.19	Professional		$67.61	$120.23	$501.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $39.81 / $323.59	Professional	26	$28.18	$39.81	$323.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $50.12 / $323.59	Professional	TC	$34.67	$50.12	$323.59
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $147.91 / $199.53	Professional		$134.90	$147.91	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $67.61 / $95.50	Professional	26	$60.26	$67.61	$95.50
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $85.11 / $104.71	Professional	TC	$74.13	$85.11	$104.71
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $173.78 / $177.83	Professional		$154.88	$173.78	$177.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $70.79 / $79.43	Professional	26	$61.66	$70.79	$79.43
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $97.72 / $109.65	Professional	TC	$85.11	$97.72	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $81.28 / $147.91	Professional		$64.57	$81.28	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $36.31 / $67.61	Professional	26	$28.18	$36.31	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $43.65 / $83.18	Professional	TC	$34.67	$43.65	$83.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $141.25	Professional		$120.23	$120.23	$141.25
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 $67.61 / $67.61 / $79.43	Professional	TC	$67.61	$67.61	$79.43