Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $582.78 / $2,977.00 / $4,778.89	Facility		$582.78	$2,977.00	$4,778.89
Aetna Facility/Professional Facility Modifier 52 Low / Median / High Price $821.60 / $5,077.60 / $5,077.60	Facility	52	$821.60	$5,077.60	$5,077.60
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $153.37 / $291.39 / $542.39	Facility	53	$153.37	$291.39	$542.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.36 / $357.12 / $1,052.74	Professional		$177.36	$357.12	$1,052.74
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $57.69 / $137.25 / $298.83	Professional	53	$57.69	$137.25	$298.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $953.00 / $953.00 / $953.00	Facility		$953.00	$953.00	$953.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.45 / $506.82 / $952.39	Professional		$244.45	$506.82	$952.39
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $175.89 / $254.85 / $425.91	Professional	53	$175.89	$254.85	$425.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $172.90 / $456.23 / $976.00	Professional		$172.90	$456.23	$976.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $306.73 / $646.04 / $1,528.28	Facility		$306.73	$646.04	$1,528.28
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $663.66 / $663.66 / $663.66	Facility	52	$663.66	$663.66	$663.66
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $165.92 / $165.92 / $165.92	Facility	53	$165.92	$165.92	$165.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $374.57 / $736.00 / $2,761.67	Professional		$374.57	$736.00	$2,761.67
Midlands Facility/Professional Facility Modifier Low / Median / High Price $398.84 / $737.26 / $953.00	Facility		$398.84	$737.26	$953.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.84 / $631.17 / $952.39	Professional		$398.84	$631.17	$952.39
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $454.69 / $1,275.23 / $3,634.42	Facility		$454.69	$1,275.23	$3,634.42
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $136.32 / $308.10 / $710.20	Professional		$136.32	$308.10	$710.20
United Facility/Professional Facility Modifier Low / Median / High Price $637.00 / $3,044.00 / $5,934.99	Facility		$637.00	$3,044.00	$5,934.99
United Facility/Professional Professional Modifier Low / Median / High Price $344.05 / $593.82 / $1,016.11	Professional		$344.05	$593.82	$1,016.11
United Facility/Professional Professional Modifier 53 Low / Median / High Price $100.00 / $181.62 / $361.63	Professional	53	$100.00	$181.62	$361.63
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $351.70 / $430.30 / $764.80	Professional		$351.70	$430.30	$764.80