Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.37 / $17.00 / $31.41	Facility	26	$10.37	$17.00	$31.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.84 / $7.70 / $103.00	Professional	26	$5.84	$7.70	$103.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.27 / $22.57 / $51.03	Professional	TC	$16.27	$22.57	$51.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.09 / $50.25 / $71.64	Professional	26	$24.09	$50.25	$71.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.27 / $162.61 / $231.82	Professional	TC	$49.27	$162.61	$231.82
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $31.28 / $59.52	Professional	26	$25.00	$31.28	$59.52
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.70 / $86.52 / $114.63	Professional	TC	$70.70	$86.52	$114.63
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $57.75 / $110.49 / $110.49	Facility	26	$57.75	$110.49	$110.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $149.40 / $149.40 / $149.40	Professional	26	$149.40	$149.40	$149.40
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $393.12 / $393.12 / $393.12	Professional	TC	$393.12	$393.12	$393.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.52 / $25.52 / $25.52	Professional	26	$25.52	$25.52	$25.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.09 / $139.60 / $184.26	Professional	TC	$81.09	$139.60	$184.26
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $38.47 / $48.70 / $57.30	Professional	26	$38.47	$48.70	$57.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $120.71 / $152.80 / $179.80	Professional	TC	$120.71	$152.80	$179.80