Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.73 / $138.83 / $187.28	Facility		$77.73	$138.83	$187.28
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $138.60 / $168.36 / $212.52	Facility	25	$138.60	$168.36	$212.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.81 / $104.87 / $280.95	Professional		$65.81	$104.87	$280.95
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $65.81 / $115.91 / $287.98	Professional	25	$65.81	$115.91	$287.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.44 / $157.83 / $250.97	Professional		$87.44	$157.83	$250.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $76.05 / $142.59 / $232.27	Professional		$76.05	$142.59	$232.27
Medica Facility/Professional Facility Modifier Low / Median / High Price $73.06 / $137.31 / $211.94	Facility		$73.06	$137.31	$211.94
Medica Facility/Professional Professional Modifier Low / Median / High Price $111.85 / $187.09 / $699.27	Professional		$111.85	$187.09	$699.27
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $119.85 / $164.54 / $262.17	Professional	25	$119.85	$164.54	$262.17
Midlands Facility/Professional Facility Modifier Low / Median / High Price $118.88 / $163.52 / $215.00	Facility		$118.88	$163.52	$215.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $118.88 / $161.41 / $215.37	Professional		$118.88	$161.41	$215.37
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $109.17 / $109.17 / $914.13	Facility		$109.17	$109.17	$914.13
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $76.31 / $135.44 / $206.77	Professional		$76.31	$135.44	$206.77
United Facility/Professional Professional Modifier Low / Median / High Price $103.88 / $137.10 / $236.10	Professional		$103.88	$137.10	$236.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $98.60 / $126.01 / $159.50	Professional		$98.60	$126.01	$159.50