Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $112.20 / $288.40	Facility		$26.92	$112.20	$288.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $26.92 / $169.82	Professional		$19.95	$26.92	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $52.48 / $66.07	Professional		$33.11	$52.48	$66.07
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $47.86 / $128.82	Professional		$26.92	$47.86	$128.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $36.31 / $114.82	Facility		$26.92	$36.31	$114.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $27.54 / $70.79	Professional		$16.22	$27.54	$70.79
Midlands Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $35.48	Professional		$32.36	$33.11	$35.48
Midlands Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $33.11 / $33.11	Facility		$33.11	$33.11	$33.11
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $3,162.28 / $4,265.80	Facility		$1,479.11	$3,162.28	$4,265.80
United Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $26.92 / $60.26	Facility		$26.92	$26.92	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $16.22 / $16.60 / $63.10	Professional		$16.22	$16.60	$63.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $26.92 / $26.92	Professional		$21.38	$26.92	$26.92