Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $75.86	Facility		$53.70	$53.70	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $61.66 / $208.93	Professional		$38.90	$61.66	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $102.33 / $165.96	Professional		$79.43	$102.33	$165.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $83.18 / $389.05	Professional		$39.81	$83.18	$389.05
Medica Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $120.23 / $213.80	Facility		$54.95	$120.23	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $131.83 / $691.83	Professional		$81.28	$131.83	$691.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $128.82 / $181.97	Professional		$93.33	$128.82	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $128.82 / $199.53	Professional		$112.20	$128.82	$199.53
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $67.61 / $128.82	Professional		$37.15	$67.61	$128.82
United Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $239.88 / $309.03	Facility		$138.04	$239.88	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $100.00 / $165.96	Professional		$53.70	$100.00	$165.96
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $93.33 / $134.90	Professional		$79.43	$93.33	$134.90