Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.10 / $163.58 / $364.32	Facility		$134.10	$163.58	$364.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.50 / $79.73 / $288.22	Professional		$60.50	$79.73	$288.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.08 / $166.46 / $208.08	Professional		$110.08	$166.46	$208.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $91.66 / $151.24 / $439.54	Professional		$91.66	$151.24	$439.54
Medica Facility/Professional Facility Modifier Low / Median / High Price $91.66 / $119.16 / $257.08	Facility		$91.66	$119.16	$257.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $94.41 / $458.30	Professional		$55.00	$94.41	$458.30
Midlands Facility/Professional Facility Modifier Low / Median / High Price $109.99 / $186.75 / $257.08	Facility		$109.99	$186.75	$257.08
Midlands Facility/Professional Professional Modifier Low / Median / High Price $110.08 / $186.75 / $262.63	Professional		$110.08	$186.75	$262.63
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $410.98 / $410.98 / $410.98	Facility		$410.98	$410.98	$410.98
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $91.66 / $91.66 / $163.61	Professional		$91.66	$91.66	$163.61
United Facility/Professional Facility Modifier Low / Median / High Price $91.66 / $91.66 / $91.66	Facility		$91.66	$91.66	$91.66
United Facility/Professional Professional Modifier Low / Median / High Price $55.00 / $55.00 / $222.03	Professional		$55.00	$55.00	$222.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $91.66 / $91.66 / $91.66	Professional		$91.66	$91.66	$91.66