Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $48.98 / $295.12	Facility	26	$48.98	$48.98	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $204.17 / $524.81	Professional		$173.78	$204.17	$524.81
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $177.83 / $181.97 / $186.21	Facility	26	$177.83	$181.97	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $501.19 / $630.96	Professional		$501.19	$501.19	$630.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $316.23 / $870.96	Professional		$181.97	$316.23	$870.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $95.50 / $181.97	Professional	26	$56.23	$95.50	$181.97
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $181.97 / $181.97 / $257.04	Facility	26	$181.97	$181.97	$257.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $426.58 / $1,148.15	Professional		$223.87	$426.58	$1,148.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $501.19 / $1,202.26	Professional		$416.87	$501.19	$1,202.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $128.82 / $218.78	Professional	26	$109.65	$128.82	$218.78
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $186.21 / $186.21	Facility	26	$186.21	$186.21	$186.21
Midlands Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $537.03	Professional		$489.78	$489.78	$537.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $162.18 / $354.81	Professional		$56.23	$162.18	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $281.84 / $549.54	Professional		$213.80	$281.84	$549.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $354.81 / $416.87	Professional		$281.84	$354.81	$416.87