Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Facility		$25.00	$25.00	$25.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.00 / $25.00 / $25.00	Professional		$25.00	$25.00	$25.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $41.39 / $67.20 / $166.98	Professional		$41.39	$67.20	$166.98
Medica Facility/Professional Facility Modifier Low / Median / High Price $25.00 / $42.25 / $79.84	Facility		$25.00	$42.25	$79.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $84.07 / $84.07 / $84.07	Professional		$84.07	$84.07	$84.07
Midlands Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $67.84 / $84.07	Professional		$67.84	$67.84	$84.07
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $69.70 / $69.70	Professional		$46.77	$69.70	$69.70