Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $60.26 / $263.03	Facility	26	$60.26	$60.26	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $131.83 / $275.42	Professional		$107.15	$131.83	$275.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $162.18 / $165.96	Facility	26	$158.49	$162.18	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $316.23 / $389.05	Professional		$151.36	$316.23	$389.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $181.97 / $489.78	Professional		$120.23	$181.97	$489.78
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $93.33 / $190.55	Professional	26	$64.57	$93.33	$190.55
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $309.03 / $309.03	Facility	26	$162.18	$309.03	$309.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $223.87 / $1,202.26	Professional		$128.82	$223.87	$1,202.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $288.40 / $398.11	Professional		$245.47	$288.40	$398.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $144.54 / $190.55	Professional	26	$102.33	$144.54	$190.55
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	26	$165.96	$165.96	$165.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $309.03 / $338.84	Professional		$263.03	$309.03	$338.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $123.03 / $234.42	Professional		$64.57	$123.03	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $154.88 / $288.40	Professional		$117.49	$154.88	$288.40
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $229.09 / $269.15	Professional		$229.09	$229.09	$269.15