Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $25.12 / $38.02	Facility	26	$25.12	$25.12	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $87.10 / $141.25	Professional		$75.86	$87.10	$141.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $87.10 / $89.13	Facility	26	$83.18	$87.10	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $223.87 / $275.42	Professional		$102.33	$223.87	$275.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $346.74 / $524.81	Professional		$91.20	$346.74	$524.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $114.82 / $158.49	Professional	26	$28.84	$114.82	$158.49
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $125.89 / $125.89	Facility	26	$87.10	$125.89	$125.89
Medica Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $134.90 / $602.56	Professional		$87.10	$134.90	$602.56
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $199.53 / $363.08	Professional		$169.82	$199.53	$363.08
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $61.66 / $117.49	Professional	26	$54.95	$61.66	$117.49
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $89.13	Facility	26	$89.13	$89.13	$89.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $239.88 / $363.08	Professional		$218.78	$239.88	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $107.15 / $204.17	Professional		$89.13	$107.15	$204.17
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $194.98	Professional		$165.96	$165.96	$194.98