Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $169.82 / $380.19	Professional		$109.65	$169.82	$380.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $331.13 / $416.87	Professional		$288.40	$331.13	$416.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $154.88 / $218.78	Professional		$109.65	$154.88	$218.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $316.23 / $1,023.29	Facility		$138.04	$316.23	$1,023.29
Medica Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $213.80 / $407.38	Professional		$123.03	$213.80	$407.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $288.40 / $407.38	Professional		$186.21	$288.40	$407.38
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $239.88 / $316.23	Professional		$134.90	$239.88	$316.23
United Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $1,023.29 / $1,318.26	Facility		$588.84	$1,023.29	$1,318.26
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $199.53 / $354.81	Professional		$117.49	$199.53	$354.81
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $223.87 / $269.15	Professional		$177.83	$223.87	$269.15