Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.82 / $84.73 / $258.91	Facility	26	$45.82	$84.73	$258.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.42 / $342.11 / $1,942.00	Professional		$267.42	$342.11	$1,942.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.60 / $49.15 / $246.00	Professional	26	$44.60	$49.15	$246.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $222.82 / $240.14 / $782.10	Professional	TC	$222.82	$240.14	$782.10
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $152.54 / $157.12 / $161.69	Facility	26	$152.54	$157.12	$161.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $632.63 / $699.68 / $874.60	Professional		$632.63	$699.68	$874.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.61 / $112.48 / $140.60	Professional	26	$104.61	$112.48	$140.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $528.02 / $587.20 / $734.01	Professional	TC	$528.02	$587.20	$734.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $256.54 / $385.06 / $1,360.92	Professional		$256.54	$385.06	$1,360.92
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $66.66 / $173.37	Professional	26	$46.00	$66.66	$173.37
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $210.54 / $329.25 / $1,187.55	Professional	TC	$210.54	$329.25	$1,187.55
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $157.12 / $157.12 / $157.12	Facility	26	$157.12	$157.12	$157.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $314.12 / $409.05 / $1,156.95	Professional		$314.12	$409.05	$1,156.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $51.09 / $61.79 / $179.78	Professional	26	$51.09	$61.79	$179.78
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $262.63 / $314.20 / $977.17	Professional	TC	$262.63	$314.20	$977.17
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $157.12 / $161.69 / $276.24	Facility	26	$157.12	$161.69	$276.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $517.39 / $669.55 / $891.58	Professional		$517.39	$669.55	$891.58
United Facility/Professional Professional Modifier Low / Median / High Price $314.12 / $361.24 / $632.72	Professional		$314.12	$361.24	$632.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.38 / $59.22 / $114.46	Professional	26	$51.38	$59.22	$114.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $262.63 / $288.89 / $535.35	Professional	TC	$262.63	$288.89	$535.35
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $401.00 / $507.60 / $597.10	Professional		$401.00	$507.60	$597.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $66.28 / $83.90 / $98.70	Professional	26	$66.28	$83.90	$98.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $334.64 / $423.60 / $498.40	Professional	TC	$334.64	$423.60	$498.40