Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $363.08 / $724.44	Facility		$64.57	$363.08	$724.44
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $257.04 / $398.11 / $954.99	Facility	25	$257.04	$398.11	$954.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $52.48 / $138.04	Professional		$30.90	$52.48	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $77.62 / $97.72	Professional		$38.02	$77.62	$97.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $58.88 / $204.17	Professional		$38.90	$58.88	$204.17
Medica Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $60.26 / $93.33	Facility		$36.31	$60.26	$93.33
Medica Facility/Professional Facility Modifier 25 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	25	$125.89	$125.89	$125.89
Medica Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $67.61 / $501.19	Professional		$40.74	$67.61	$501.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $77.62 / $93.33	Professional		$60.26	$77.62	$93.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $83.18 / $112.20	Professional		$77.62	$83.18	$112.20
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $2,951.21	Facility		$1,096.48	$1,096.48	$2,951.21
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $74.13 / $95.50	Professional		$41.69	$74.13	$95.50
United Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $416.87 / $416.87	Facility		$416.87	$416.87	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $53.70 / $97.72	Professional		$40.74	$53.70	$97.72
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $69.18 / $69.18	Professional		$58.88	$69.18	$69.18