Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $60.26 / $81.28	Facility	26	$57.54	$60.26	$81.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $275.42 / $1,412.54	Professional		$208.93	$275.42	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $363.08	Professional	26	$57.54	$74.13	$363.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $194.98 / $1,047.13	Professional	TC	$151.36	$194.98	$1,047.13
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $190.55 / $194.98	Facility	26	$181.97	$190.55	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $524.81 / $660.69	Professional		$512.86	$524.81	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $144.54 / $177.83	Professional	26	$141.25	$144.54	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $380.19 / $478.63	Professional	TC	$363.08	$380.19	$478.63
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $331.13 / $1,412.54	Professional		$190.55	$331.13	$1,412.54
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $87.10 / $380.19	Professional	26	$61.66	$87.10	$380.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $208.93 / $1,096.48	Professional	TC	$151.36	$208.93	$1,096.48
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $575.44	Facility	26	$190.55	$190.55	$575.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $446.68 / $1,659.59	Professional		$239.88	$446.68	$1,659.59
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $74.13 / $436.52	Professional	26	$54.95	$74.13	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $281.84 / $3,019.95	Professional	TC	$162.18	$281.84	$3,019.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $512.86 / $1,698.24	Professional		$436.52	$512.86	$1,698.24
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $141.25 / $218.78	Professional	26	$123.03	$141.25	$218.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $363.08 / $2,089.30	Professional	TC	$309.03	$363.08	$2,089.30
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $194.98 / $194.98	Facility	26	$194.98	$194.98	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $616.60	Professional		$512.86	$512.86	$616.60
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $144.54 / $165.96	Professional	26	$144.54	$144.54	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $371.54 / $446.68	Professional	TC	$371.54	$371.54	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $316.23 / $630.96	Professional		$229.09	$316.23	$630.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $158.49	Professional	26	$57.54	$74.13	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $223.87 / $562.34	Professional	TC	$162.18	$223.87	$562.34
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $416.87 / $489.78	Professional		$331.13	$416.87	$489.78
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $117.49 / $138.04	Professional	26	$93.33	$117.49	$138.04
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $302.00 / $354.81	Professional	TC	$239.88	$302.00	$354.81