Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.20 / $18.20 / $109.65	Facility	26	$18.20	$18.20	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $169.82 / $446.68	Professional		$144.54	$169.82	$446.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $66.07 / $67.61	Facility	26	$64.57	$66.07	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $426.58 / $524.81	Professional		$407.38	$426.58	$524.81
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $234.42 / $691.83	Professional		$151.36	$234.42	$691.83
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $33.88 / $61.66	Professional	26	$20.42	$33.88	$61.66
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $66.07 / $100.00	Facility	26	$66.07	$66.07	$100.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $269.15 / $588.84	Professional		$154.88	$269.15	$588.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $407.38 / $524.81	Professional		$338.84	$407.38	$524.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $46.77 / $79.43	Professional	26	$39.81	$46.77	$79.43
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $67.61 / $67.61	Facility	26	$67.61	$67.61	$67.61
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $446.68	Professional		$407.38	$407.38	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $204.17 / $426.58	Professional		$154.88	$204.17	$426.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $302.00 / $354.81	Professional		$234.42	$302.00	$354.81