Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Facility		$109.65	$109.65	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $81.28 / $109.65	Professional		$72.44	$81.28	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $100.00 / $199.53	Professional		$60.26	$100.00	$199.53
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $0.85 / $1.15 / $64.57	Professional		$0.85	$1.15	$64.57
Medica Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $107.15 / $169.82	Facility		$66.07	$107.15	$169.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $158.49 / $524.81	Professional		$93.33	$158.49	$524.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $151.36 / $199.53	Professional		$93.33	$151.36	$199.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $89.13 / $199.53	Professional		$77.62	$89.13	$199.53
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $91.20 / $107.15	Professional		$79.43	$91.20	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $218.78	Professional		$89.13	$131.83	$218.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $141.25 / $141.25	Professional		$112.20	$141.25	$141.25