Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $79.43 / $416.87	Facility	26	$79.43	$79.43	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $426.58 / $851.14	Professional		$323.59	$426.58	$851.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $239.88 / $251.19 / $257.04	Facility	26	$239.88	$251.19	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $812.83 / $1,096.48	Professional		$478.63	$812.83	$1,096.48
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $575.44 / $1,905.46	Professional		$302.00	$575.44	$1,905.46
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $371.54	Professional	26	$70.79	$128.82	$371.54
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $562.34 / $724.44 / $724.44	Facility	26	$562.34	$724.44	$724.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $724.44 / $3,388.44	Professional		$426.58	$724.44	$3,388.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,000.00 / $1,122.02	Professional		$660.69	$1,000.00	$1,122.02
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $177.83 / $239.88	Professional	26	$154.88	$177.83	$239.88
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $257.04 / $257.04	Facility	26	$257.04	$257.04	$257.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $776.25 / $1,096.48	Professional		$776.25	$776.25	$1,096.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $263.03 / $562.34	Professional		$77.62	$263.03	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $562.34 / $1,148.15	Professional		$389.05	$562.34	$1,148.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $870.96	Professional		$741.31	$741.31	$870.96