Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.95 / $115.32 / $115.32	Facility	26	$91.95	$115.32	$115.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $386.46 / $416.05 / $3,367.73	Professional		$386.46	$416.05	$3,367.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.70 / $66.48 / $405.65	Professional	26	$60.70	$66.48	$405.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $325.76 / $325.76 / $2,951.25	Professional	TC	$325.76	$325.76	$2,951.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $198.78 / $204.74 / $210.71	Facility	26	$198.78	$204.74	$210.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $907.32 / $1,005.31 / $1,256.63	Professional		$907.32	$1,005.31	$1,256.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.61 / $152.81 / $191.02	Professional	26	$141.61	$152.81	$191.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $765.71 / $852.49 / $1,065.61	Professional	TC	$765.71	$852.49	$1,065.61
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $417.19 / $625.78 / $2,366.06	Professional		$417.19	$625.78	$2,366.06
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.64 / $102.66 / $311.99	Professional	26	$68.64	$102.66	$311.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $352.21 / $523.10 / $1,542.53	Professional	TC	$352.21	$523.10	$1,542.53
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $204.74 / $204.74 / $204.74	Facility	26	$204.74	$204.74	$204.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $463.64 / $595.52 / $1,720.75	Professional		$463.64	$595.52	$1,720.75
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $70.23 / $81.34 / $249.49	Professional	26	$70.23	$81.34	$249.49
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $392.91 / $471.49 / $1,471.26	Professional	TC	$392.91	$471.49	$1,471.26
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $204.74 / $210.71 / $373.80	Facility	26	$204.74	$210.71	$373.80
Midlands Facility/Professional Professional Modifier Low / Median / High Price $820.36 / $976.64 / $1,667.93	Professional		$820.36	$976.64	$1,667.93
United Facility/Professional Professional Modifier Low / Median / High Price $463.64 / $533.19 / $934.75	Professional		$463.64	$533.19	$934.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.94 / $81.34 / $136.51	Professional	26	$69.94	$81.34	$136.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $386.91 / $471.49 / $801.09	Professional	TC	$386.91	$471.49	$801.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $575.12 / $728.00 / $856.40	Professional		$575.12	$728.00	$856.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $89.74 / $113.60 / $133.69	Professional	26	$89.74	$113.60	$133.69
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $485.30 / $614.29 / $722.70	Professional	TC	$485.30	$614.29	$722.70