Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $124.18 / $1,647.00 / $5,549.00	Facility		$124.18	$1,647.00	$5,549.00
Aetna Facility/Professional Facility Modifier 50 Low / Median / High Price $728.08 / $1,126.50 / $1,924.65	Facility	50	$728.08	$1,126.50	$1,924.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.93 / $84.52 / $292.79	Professional		$48.93	$84.52	$292.79
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $69.34 / $142.94 / $439.19	Professional	50	$69.34	$142.94	$439.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.00 / $172.37 / $261.97	Professional		$108.00	$172.37	$261.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $47.21 / $109.98 / $339.37	Professional		$47.21	$109.98	$339.37
Medica Facility/Professional Facility Modifier Low / Median / High Price $82.30 / $139.93 / $291.00	Facility		$82.30	$139.93	$291.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $97.10 / $172.37 / $483.00	Professional		$97.10	$172.37	$483.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $110.63 / $165.90 / $237.22	Facility		$110.63	$165.90	$237.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $106.62 / $165.90 / $244.97	Professional		$106.62	$165.90	$244.97
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $694.77 / $694.77 / $694.77	Facility		$694.77	$694.77	$694.77
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 $88.83 / $148.04 / $275.39	Professional		$88.83	$148.04	$275.39
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $97.50 / $137.93 / $205.40	Professional		$97.50	$137.93	$205.40