Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $263.03 / $457.09	Facility		$128.82	$263.03	$457.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $144.54 / $338.84	Professional		$112.20	$144.54	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $323.59 / $407.38	Professional		$218.78	$323.59	$407.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $281.84 / $363.08	Professional		$151.36	$281.84	$363.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $204.17 / $389.05	Facility		$169.82	$204.17	$389.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $204.17 / $501.19	Professional		$77.62	$204.17	$501.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $218.78	Professional		$204.17	$204.17	$218.78
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $181.97 / $363.08	Professional		$169.82	$181.97	$363.08
United Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $169.82 / $389.05	Facility		$169.82	$169.82	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $102.33 / $371.54	Professional		$77.62	$102.33	$371.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $169.82	Professional		$169.82	$169.82	$169.82