Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.78 / $109.01 / $200.85	Facility	26	$55.78	$109.01	$200.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.83 / $87.17 / $357.00	Professional		$77.83	$87.17	$357.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.89 / $110.10 / $113.30	Facility	26	$106.89	$110.10	$113.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.40 / $206.34 / $258.14	Professional		$108.40	$206.34	$258.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $77.43 / $136.43 / $472.25	Professional		$77.43	$136.43	$472.25
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.89 / $53.47 / $172.49	Professional	26	$30.89	$53.47	$172.49
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $110.10 / $149.85 / $149.85	Facility	26	$110.10	$149.85	$149.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.57 / $155.13 / $579.01	Professional		$89.57	$155.13	$579.01
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $110.10 / $113.30 / $187.38	Facility	26	$110.10	$113.30	$187.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $155.47 / $187.15 / $258.14	Professional		$155.47	$187.15	$258.14
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $33.04 / $62.31 / $149.51	Professional		$33.04	$62.31	$149.51
United Facility/Professional Professional Modifier Low / Median / High Price $87.13 / $110.44 / $196.02	Professional		$87.13	$110.44	$196.02
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.16 / $155.90 / $183.40	Professional		$123.16	$155.90	$183.40