Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $133.32 / $240.60 / $525.57	Facility		$133.32	$240.60	$525.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.63 / $107.60 / $176.00	Professional		$81.63	$107.60	$176.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.53 / $224.56 / $280.70	Professional		$148.53	$224.56	$280.70
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $123.68 / $204.07 / $425.64	Professional		$123.68	$204.07	$425.64
Medica Facility/Professional Facility Modifier Low / Median / High Price $123.68 / $160.78 / $346.85	Facility		$123.68	$160.78	$346.85
Medica Facility/Professional Professional Modifier Low / Median / High Price $74.20 / $127.39 / $618.40	Professional		$74.20	$127.39	$618.40
Midlands Facility/Professional Facility Modifier Low / Median / High Price $148.41 / $251.97 / $346.85	Facility		$148.41	$251.97	$346.85
Midlands Facility/Professional Professional Modifier Low / Median / High Price $148.53 / $251.97 / $354.33	Professional		$148.53	$251.97	$354.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.68 / $123.68 / $220.77	Professional		$123.68	$123.68	$220.77
United Facility/Professional Facility Modifier Low / Median / High Price $123.68 / $123.68 / $284.45	Facility		$123.68	$123.68	$284.45
United Facility/Professional Professional Modifier Low / Median / High Price $74.20 / $74.20 / $312.79	Professional		$74.20	$74.20	$312.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.68 / $123.68 / $123.68	Professional		$123.68	$123.68	$123.68