Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $2,630.27 / $5,248.07	Facility		$575.44	$2,630.27	$5,248.07
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $812.83 / $5,128.61 / $5,128.61	Facility	52	$812.83	$5,128.61	$5,128.61
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $144.54 / $281.84 / $562.34	Facility	53	$144.54	$281.84	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $371.54 / $1,621.81	Professional		$177.83	$371.54	$1,621.81
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $83.18 / $162.18 / $416.87	Professional	53	$83.18	$162.18	$416.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $489.78 / $954.99	Professional		$223.87	$489.78	$954.99
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $177.83 / $251.19 / $436.52	Professional	53	$177.83	$251.19	$436.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $524.81 / $1,000.00	Professional		$173.78	$524.81	$1,000.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $630.96 / $2,041.74	Facility		$263.03	$630.96	$2,041.74
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	52	$660.69	$660.69	$660.69
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	53	$165.96	$165.96	$165.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $676.08 / $2,754.23	Professional		$371.54	$676.08	$2,754.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $741.31 / $891.25	Professional		$436.52	$741.31	$891.25
Midlands Facility/Professional Professional Modifier 53 Low / Median / High Price $204.17 / $257.04 / $416.87	Professional	53	$204.17	$257.04	$416.87
Midlands Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $616.60 / $933.25	Professional		$426.58	$616.60	$933.25
Midlands Facility/Professional Professional Modifier 53 Low / Median / High Price $104.71 / $245.47 / $467.74	Professional	53	$104.71	$245.47	$467.74
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,288.25 / $3,548.13	Facility		$489.78	$1,288.25	$3,548.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $316.23 / $707.95	Professional		$95.50	$316.23	$707.95
United Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $2,454.71 / $5,888.44	Facility		$1,230.27	$2,454.71	$5,888.44
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $398.11 / $794.33	Professional		$213.80	$398.11	$794.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $426.58 / $758.58	Professional		$354.81	$426.58	$758.58