Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $40.00 / $40.00 / $40.00	Facility		$40.00	$40.00	$40.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.00 / $40.00 / $40.00	Professional		$40.00	$40.00	$40.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $57.20 / $67.59 / $109.60	Facility		$57.20	$67.59	$109.60
Medica Facility/Professional Professional Modifier Low / Median / High Price $690.57 / $1,009.05 / $1,009.05	Professional		$690.57	$1,009.05	$1,009.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $599.65 / $690.57 / $690.57	Professional		$599.65	$690.57	$690.57
United Facility/Professional Professional Modifier Low / Median / High Price $1,009.05 / $1,009.05 / $1,009.05	Professional		$1,009.05	$1,009.05	$1,009.05
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $575.00 / $575.00 / $575.00	Professional		$575.00	$575.00	$575.00