Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.68 / $95.30 / $291.38	Facility	26	$51.68	$95.30	$291.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.38 / $197.96 / $1,166.71	Professional		$151.38	$197.96	$1,166.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.16 / $55.05 / $299.02	Professional	26	$50.16	$55.05	$299.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.22 / $101.22 / $825.39	Professional	TC	$101.22	$101.22	$825.39
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $175.34 / $180.60 / $185.86	Facility	26	$175.34	$180.60	$185.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $375.03 / $411.90 / $514.87	Professional		$375.03	$411.90	$514.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.14 / $127.21 / $159.02	Professional	26	$118.14	$127.21	$159.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $256.89 / $284.68 / $355.85	Professional	TC	$256.89	$284.68	$355.85
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $154.41 / $285.45 / $638.28	Professional		$154.41	$285.45	$638.28
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.96 / $96.24 / $203.97	Professional	26	$51.96	$96.24	$203.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.45 / $193.85 / $462.28	Professional	TC	$102.45	$193.85	$462.28
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $180.60 / $180.60 / $180.60	Facility	26	$180.60	$180.60	$180.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $167.95 / $270.61 / $818.42	Professional		$167.95	$270.61	$818.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $57.85 / $66.53 / $232.74	Professional	26	$57.85	$66.53	$232.74
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $110.10 / $143.37 / $652.63	Professional	TC	$110.10	$143.37	$652.63
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $180.60 / $185.86 / $310.98	Facility	26	$180.60	$185.86	$310.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $327.38 / $375.03 / $501.22	Professional		$327.38	$375.03	$501.22
United Facility/Professional Professional Modifier Low / Median / High Price $167.95 / $193.14 / $333.61	Professional		$167.95	$193.14	$333.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.69 / $66.53 / $128.60	Professional	26	$57.69	$66.53	$128.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.10 / $126.61 / $224.22	Professional	TC	$110.10	$126.61	$224.22
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $237.71 / $300.89 / $354.00	Professional		$237.71	$300.89	$354.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $74.89 / $94.80 / $111.50	Professional	26	$74.89	$94.80	$111.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $162.82 / $206.10 / $242.50	Professional	TC	$162.82	$206.10	$242.50