Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $81.28 / $91.20	Facility		$81.28	$81.28	$91.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $64.57 / $208.93	Professional		$54.95	$64.57	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $125.89 / $263.03	Professional		$47.86	$125.89	$263.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $72.44 / $218.78	Professional		$52.48	$72.44	$218.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $56.23 / $81.28 / $147.91	Facility		$56.23	$81.28	$147.91
Medica Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $104.71 / $416.87	Professional		$52.48	$104.71	$416.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $134.90 / $169.82	Professional		$81.28	$134.90	$169.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $177.83	Professional		$147.91	$147.91	$177.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $77.62 / $154.88	Professional		$53.70	$77.62	$154.88
United Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $46.77 / $46.77	Facility		$46.77	$46.77	$46.77
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $91.20 / $162.18	Professional		$53.70	$91.20	$162.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $87.10 / $102.33	Professional		$77.62	$87.10	$102.33