Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Facility		$141.25	$141.25	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $109.65 / $234.42	Professional		$91.20	$109.65	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $194.98 / $269.15	Professional		$97.72	$194.98	$269.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $218.78 / $389.05	Professional		$97.72	$218.78	$389.05
Medica Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $204.17 / $263.03	Facility		$104.71	$204.17	$263.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $194.98 / $1,348.96	Professional		$112.20	$194.98	$1,348.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $245.47 / $269.15	Professional		$194.98	$245.47	$269.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $213.80 / $269.15	Professional		$190.55	$213.80	$269.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $162.18 / $208.93	Professional		$89.13	$162.18	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $162.18 / $275.42	Professional		$107.15	$162.18	$275.42
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $218.78	Professional		$147.91	$186.21	$218.78