Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.81 / $112.26 / $206.92	Facility	26	$54.81	$112.26	$206.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.97 / $126.37 / $495.00	Professional		$101.97	$126.37	$495.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.83 / $112.09 / $115.36	Facility	26	$108.83	$112.09	$115.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.19 / $268.39 / $335.49	Professional		$110.19	$268.39	$335.49
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $99.93 / $167.99 / $378.12	Professional		$99.93	$167.99	$378.12
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.82 / $58.72 / $116.52	Professional	26	$31.82	$58.72	$116.52
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $112.09 / $154.38 / $154.38	Facility	26	$112.09	$154.38	$154.38
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.70 / $169.76 / $756.60	Professional		$111.70	$169.76	$756.60
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $112.09 / $115.36 / $193.08	Facility	26	$112.09	$115.36	$193.08
Midlands Facility/Professional Professional Modifier Low / Median / High Price $160.44 / $243.39 / $323.30	Professional		$160.44	$243.39	$323.30
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $34.61 / $110.16 / $193.48	Professional		$34.61	$110.16	$193.48
United Facility/Professional Professional Modifier Low / Median / High Price $110.45 / $145.18 / $243.91	Professional		$110.45	$145.18	$243.91
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $160.21 / $202.80 / $238.50	Professional		$160.21	$202.80	$238.50