Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $112.20 / $151.36	Facility		$53.70	$112.20	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $104.71 / $257.04	Professional		$58.88	$104.71	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $154.88 / $181.97	Professional		$97.72	$154.88	$181.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $141.25 / $245.47	Professional		$77.62	$141.25	$245.47
Medica Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $131.83 / $194.98	Facility		$74.13	$131.83	$194.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $616.60	Professional		$97.72	$162.18	$616.60
Midlands Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $162.18 / $194.98	Professional		$120.23	$162.18	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $204.17 / $204.17	Professional		$154.88	$204.17	$204.17
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $30,199.52 / $41,686.94	Facility		$3,801.89	$30,199.52	$41,686.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $138.04 / $173.78	Professional		$77.62	$138.04	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $117.49 / $213.80	Professional		$91.20	$117.49	$213.80
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $125.89 / $138.04	Professional		$107.15	$125.89	$138.04