Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $112.20 / $245.47	Facility	26	$100.00	$112.20	$245.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $229.09 / $416.87	Professional	26	$100.00	$229.09	$416.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $363.08 / $380.19 / $389.05	Facility	26	$363.08	$380.19	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $269.15 / $331.13	Professional	26	$263.03	$269.15	$331.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $162.18 / $229.09	Professional	26	$114.82	$162.18	$229.09
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $1,071.52	Facility	26	$380.19	$380.19	$1,071.52
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $134.90 / $1,202.26	Professional	26	$107.15	$134.90	$1,202.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $263.03 / $616.60	Professional	26	$229.09	$263.03	$616.60
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $389.05 / $389.05 / $389.05	Facility	26	$389.05	$389.05	$389.05
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $263.03 / $309.03	Professional	26	$263.03	$263.03	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $134.90 / $302.00	Professional	26	$112.20	$134.90	$302.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $213.80 / $251.19	Professional	26	$169.82	$213.80	$251.19