Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $194.98	Facility	26	$32.36	$32.36	$194.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $165.96 / $436.52	Professional		$141.25	$165.96	$436.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $120.23 / $123.03	Facility	26	$114.82	$120.23	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $407.38 / $512.86	Professional		$389.05	$407.38	$512.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $229.09 / $676.08	Professional		$151.36	$229.09	$676.08
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $60.26 / $112.20	Professional	26	$36.31	$60.26	$112.20
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $120.23 / $169.82	Facility	26	$120.23	$120.23	$169.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $288.40 / $575.44	Professional		$173.78	$288.40	$575.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $363.08 / $457.09	Professional		$331.13	$363.08	$457.09
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $83.18 / $144.54	Professional	26	$72.44	$83.18	$144.54
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	26	$123.03	$123.03	$123.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $398.11 / $436.52	Professional		$398.11	$398.11	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $199.53 / $446.68	Professional		$162.18	$199.53	$446.68
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $295.12 / $346.74	Professional		$229.09	$295.12	$346.74