Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $221.99 / $668.13 / $5,463.36	Facility		$221.99	$668.13	$5,463.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $116.84 / $278.81 / $901.21	Professional		$116.84	$278.81	$901.21
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $58.42 / $175.83 / $232.49	Professional	52	$58.42	$175.83	$232.49
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $23.37 / $44.69 / $70.33	Professional	53	$23.37	$44.69	$70.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.63 / $388.48 / $647.34	Professional		$177.63	$388.48	$647.34
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $74.09 / $302.24 / $576.47	Professional		$74.09	$302.24	$576.47
Medica Facility/Professional Facility Modifier Low / Median / High Price $197.39 / $479.61 / $2,195.54	Facility		$197.39	$479.61	$2,195.54
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $289.45 / $289.45 / $289.45	Facility	52	$289.45	$289.45	$289.45
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $72.36 / $72.36 / $72.36	Facility	53	$72.36	$72.36	$72.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $211.37 / $474.32 / $1,775.04	Professional		$211.37	$474.32	$1,775.04
Midlands Facility/Professional Facility Modifier Low / Median / High Price $190.70 / $474.32 / $652.36	Facility		$190.70	$474.32	$652.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.95 / $340.56 / $647.34	Professional		$173.95	$340.56	$647.34
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $728.17 / $728.17 / $728.17	Facility		$728.17	$728.17	$728.17
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.00 / $367.40 / $661.00	Professional		$3.00	$367.40	$661.00
United Facility/Professional Facility Modifier Low / Median / High Price $1,562.00 / $3,902.18 / $5,454.00	Facility		$1,562.00	$3,902.18	$5,454.00
United Facility/Professional Professional Modifier Low / Median / High Price $237.68 / $408.02 / $644.78	Professional		$237.68	$408.02	$644.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $153.40 / $180.40 / $497.50	Professional		$153.40	$180.40	$497.50