Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.27 / $86.27 / $164.56	Facility	26	$86.27	$86.27	$164.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.47 / $121.48 / $400.40	Professional		$102.47	$121.48	$400.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $158.41 / $163.16 / $167.93	Facility	26	$158.41	$163.16	$167.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.38 / $278.48 / $348.10	Professional		$128.38	$278.48	$348.10
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $107.35 / $176.82 / $393.71	Professional		$107.35	$176.82	$393.71
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.37 / $73.61 / $169.28	Professional	26	$46.37	$73.61	$169.28
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $163.16 / $224.03 / $224.03	Facility	26	$163.16	$224.03	$224.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $114.17 / $183.11 / $735.51	Professional		$114.17	$183.11	$735.51
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $163.16 / $167.93 / $281.33	Facility	26	$163.16	$167.93	$281.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $197.23 / $247.93 / $313.64	Professional		$197.23	$247.93	$313.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $49.79 / $109.90 / $202.13	Professional		$49.79	$109.90	$202.13
United Facility/Professional Professional Modifier Low / Median / High Price $111.65 / $142.47 / $281.17	Professional		$111.65	$142.47	$281.17
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $166.77 / $211.10 / $248.30	Professional		$166.77	$211.10	$248.30