Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.24 / $85.93 / $158.58	Facility	26	$52.24	$85.93	$158.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.75 / $118.47 / $205.41	Professional		$109.75	$118.47	$205.41
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $84.47 / $87.00 / $89.54	Facility	26	$84.47	$87.00	$89.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.96 / $308.73 / $385.91	Professional		$108.96	$308.73	$385.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $113.69 / $169.72 / $257.24	Professional		$113.69	$169.72	$257.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.17 / $39.90 / $68.98	Professional	26	$25.17	$39.90	$68.98
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $87.00 / $122.62 / $122.62	Facility	26	$87.00	$122.62	$122.62
Medica Facility/Professional Professional Modifier Low / Median / High Price $114.39 / $181.19 / $891.71	Professional		$114.39	$181.19	$891.71
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $87.00 / $89.54 / $149.34	Facility	26	$87.00	$89.54	$149.34
Midlands Facility/Professional Professional Modifier Low / Median / High Price $160.00 / $261.86 / $345.88	Professional		$160.00	$261.86	$345.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.40 / $109.33 / $221.88	Professional		$27.40	$109.33	$221.88
United Facility/Professional Professional Modifier Low / Median / High Price $111.77 / $141.55 / $252.36	Professional		$111.77	$141.55	$252.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $177.28 / $224.40 / $264.00	Professional		$177.28	$224.40	$264.00