Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $289.64 / $2,563.00 / $7,119.04	Facility		$289.64	$2,563.00	$7,119.04
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $37.61 / $37.61 / $37.61	Facility	50	$37.61	$37.61	$37.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.99 / $114.29 / $303.64	Professional		$49.99	$114.29	$303.64
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.39 / $108.12 / $160.50	Professional	50	$17.39	$108.12	$160.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.89 / $220.62 / $319.43	Professional		$109.89	$220.62	$319.43
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $50.85 / $143.77 / $615.98	Professional		$50.85	$143.77	$615.98
Medica Facility/Professional Facility Modifier Low / Median / High Price $73.95 / $189.46 / $660.44	Facility		$73.95	$189.46	$660.44
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $48.61 / $48.61 / $48.61	Facility	53	$48.61	$48.61	$48.61
Medica Facility/Professional Professional Modifier Low / Median / High Price $108.55 / $226.14 / $1,133.30	Professional		$108.55	$226.14	$1,133.30
Midlands Facility/Professional Facility Modifier Low / Median / High Price $109.89 / $226.14 / $285.43	Facility		$109.89	$226.14	$285.43
Midlands Facility/Professional Professional Modifier Low / Median / High Price $109.89 / $185.63 / $285.43	Professional		$109.89	$185.63	$285.43
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $488.35 / $488.35 / $488.35	Facility		$488.35	$488.35	$488.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $46.27 / $97.33 / $199.80	Professional		$46.27	$97.33	$199.80
United Facility/Professional Facility Modifier Low / Median / High Price $1,204.00 / $1,640.00 / $2,126.00	Facility		$1,204.00	$1,640.00	$2,126.00
United Facility/Professional Professional Modifier Low / Median / High Price $108.55 / $181.04 / $323.67	Professional		$108.55	$181.04	$323.67
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $96.90 / $166.30 / $247.60	Professional		$96.90	$166.30	$247.60