Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.77 / $872.16 / $1,946.00	Facility		$173.77	$872.16	$1,946.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $421.43 / $874.93 / $1,820.97	Facility	25	$421.43	$874.93	$1,820.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.41 / $110.54 / $402.00	Professional		$87.41	$110.54	$402.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $96.51 / $185.87 / $446.76	Professional	25	$96.51	$185.87	$446.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.72 / $218.04 / $323.30	Professional		$117.72	$218.04	$323.30
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $113.36 / $171.68 / $401.91	Professional		$113.36	$171.68	$401.91
Medica Facility/Professional Facility Modifier Low / Median / High Price $107.60 / $202.64 / $296.41	Facility		$107.60	$202.64	$296.41
Medica Facility/Professional Facility Modifier 25 Low / Median / High Price $319.02 / $319.02 / $897.78	Facility	25	$319.02	$319.02	$897.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $124.57 / $213.22 / $748.12	Professional		$124.57	$213.22	$748.12
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $176.33 / $233.20 / $288.80	Professional	25	$176.33	$233.20	$288.80
Midlands Facility/Professional Facility Modifier Low / Median / High Price $168.00 / $218.04 / $297.87	Facility		$168.00	$218.04	$297.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $160.00 / $223.46 / $297.87	Professional		$160.00	$223.46	$297.87
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,207.80 / $1,207.80 / $3,261.06	Facility		$1,207.80	$1,207.80	$3,261.06
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $115.25 / $196.19 / $230.07	Professional		$115.25	$196.19	$230.07
United Facility/Professional Professional Modifier Low / Median / High Price $120.39 / $174.04 / $266.24	Professional		$120.39	$174.04	$266.24
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $156.74 / $198.40 / $198.40	Professional		$156.74	$198.40	$198.40