Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.62 / $307.62 / $307.62	Facility	26	$107.62	$307.62	$307.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $348.98 / $446.63 / $574.10	Professional	TC	$348.98	$446.63	$574.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $625.33 / $931.70 / $1,164.61	Professional	TC	$625.33	$931.70	$1,164.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.79 / $160.84 / $1,598.58	Professional	26	$107.79	$160.84	$1,598.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $370.54 / $579.04 / $4,782.63	Professional	TC	$370.54	$579.04	$4,782.63
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $429.26 / $832.39 / $2,779.03	Professional	TC	$429.26	$832.39	$2,779.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $429.26 / $770.81 / $1,119.81	Professional	TC	$429.26	$770.81	$1,119.81
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $688.41 / $871.40 / $1,025.20	Professional	TC	$688.41	$871.40	$1,025.20