Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.47 / $160.47 / $354.57	Facility	26	$64.47	$160.47	$354.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.52 / $199.74 / $261.99	Professional		$171.52	$199.74	$261.99
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $199.67 / $205.66 / $211.65	Facility	26	$199.67	$205.66	$211.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $310.58 / $575.04 / $718.82	Professional		$310.58	$575.04	$718.82
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $264.20 / $400.52 / $658.04	Professional		$264.20	$400.52	$658.04
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.67 / $92.50 / $213.18	Professional	26	$61.67	$92.50	$213.18
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $205.66 / $270.97 / $270.97	Facility	26	$205.66	$270.97	$270.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $143.49 / $266.54 / $712.19	Professional		$143.49	$266.54	$712.19
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $205.66 / $211.65 / $338.52	Facility	26	$205.66	$211.65	$338.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $299.69 / $468.13 / $659.89	Professional		$299.69	$468.13	$659.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.03 / $243.43 / $444.06	Professional		$59.03	$243.43	$444.06
United Facility/Professional Professional Modifier Low / Median / High Price $138.63 / $258.77 / $490.55	Professional		$138.63	$258.77	$490.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $456.20 / $536.70 / $631.10	Professional		$456.20	$536.70	$631.10