Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.54 / $190.93 / $279.69	Facility		$112.54	$190.93	$279.69
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $96.62 / $96.62 / $365.56	Facility	25	$96.62	$96.62	$365.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $103.37 / $165.02 / $437.28	Professional		$103.37	$165.02	$437.28
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $109.28 / $177.85 / $466.41	Professional	25	$109.28	$177.85	$466.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.22 / $245.03 / $376.26	Professional		$133.22	$245.03	$376.26
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $123.81 / $220.11 / $354.25	Professional		$123.81	$220.11	$354.25
Medica Facility/Professional Facility Modifier Low / Median / High Price $118.23 / $209.83 / $315.14	Facility		$118.23	$209.83	$315.14
Medica Facility/Professional Professional Modifier Low / Median / High Price $167.09 / $280.58 / $1,041.60	Professional		$167.09	$280.58	$1,041.60
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $246.57 / $325.08 / $507.51	Professional	25	$246.57	$325.08	$507.51
Midlands Facility/Professional Facility Modifier Low / Median / High Price $193.59 / $257.43 / $323.39	Facility		$193.59	$257.43	$323.39
Midlands Facility/Professional Professional Modifier Low / Median / High Price $193.59 / $254.63 / $331.81	Professional		$193.59	$254.63	$331.81
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $149.41 / $149.41 / $757.89	Facility		$149.41	$149.41	$757.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $124.29 / $220.04 / $311.82	Professional		$124.29	$220.04	$311.82
United Facility/Professional Facility Modifier Low / Median / High Price $188.95 / $188.95 / $188.95	Facility		$188.95	$188.95	$188.95
United Facility/Professional Professional Modifier Low / Median / High Price $163.66 / $202.57 / $361.95	Professional		$163.66	$202.57	$361.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $160.50 / $188.81 / $239.00	Professional		$160.50	$188.81	$239.00