Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $6,165.95 / $10,232.93	Facility		$1,202.26	$6,165.95	$10,232.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $831.76 / $1,995.26	Professional		$630.96	$831.76	$1,995.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,584.89 / $1,995.26	Professional		$794.33	$1,584.89	$1,995.26
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $831.76 / $3,162.28	Professional		$489.78	$831.76	$3,162.28
Medica Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $7,244.36 / $13,182.57	Facility		$831.76	$7,244.36	$13,182.57
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $4,073.80 / $4,073.80 / $4,073.80	Facility	53	$4,073.80	$4,073.80	$4,073.80
Medica Facility/Professional Facility Modifier 54 Low / Median / High Price $14,125.38 / $14,125.38 / $14,125.38	Facility	54	$14,125.38	$14,125.38	$14,125.38
Medica Facility/Professional Facility Modifier 55 Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Facility	55	$3,019.95	$3,019.95	$3,019.95
Medica Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,479.11 / $5,128.61	Professional		$794.33	$1,479.11	$5,128.61
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,621.81 / $2,511.89	Professional		$1,122.02	$1,621.81	$2,511.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $1,023.29 / $1,318.26	Professional		$575.44	$1,023.29	$1,318.26
United Facility/Professional Facility Modifier Low / Median / High Price $6,918.31 / $10,000.00 / $14,125.38	Facility		$6,918.31	$10,000.00	$14,125.38
United Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,071.52 / $1,949.84	Professional		$724.44	$1,071.52	$1,949.84
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,412.54 / $1,513.56	Professional		$1,000.00	$1,412.54	$1,513.56