Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $360.10 / $615.76 / $1,341.00	Facility		$360.10	$615.76	$1,341.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $1,073.82 / $1,504.21 / $2,639.28	Facility	25	$1,073.82	$1,504.21	$2,639.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.65 / $232.70 / $792.28	Professional		$181.65	$232.70	$792.28
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $193.27 / $305.31 / $941.72	Professional	25	$193.27	$305.31	$941.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.74 / $398.34 / $638.52	Professional		$207.74	$398.34	$638.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $203.70 / $368.56 / $1,222.96	Professional		$203.70	$368.56	$1,222.96
Medica Facility/Professional Facility Modifier Low / Median / High Price $189.53 / $361.68 / $540.47	Facility		$189.53	$361.68	$540.47
Medica Facility/Professional Professional Modifier Low / Median / High Price $287.77 / $468.86 / $1,733.52	Professional		$287.77	$468.86	$1,733.52
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $309.93 / $407.85 / $491.34	Professional	25	$309.93	$407.85	$491.34
Midlands Facility/Professional Facility Modifier Low / Median / High Price $308.58 / $420.15 / $597.37	Facility		$308.58	$420.15	$597.37
Midlands Facility/Professional Professional Modifier Low / Median / High Price $314.49 / $420.15 / $576.47	Professional		$314.49	$420.15	$576.47
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,346.64 / $9,738.54 / $19,964.07	Facility		$1,346.64	$9,738.54	$19,964.07
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $212.88 / $378.38 / $521.37	Professional		$212.88	$378.38	$521.37
United Facility/Professional Facility Modifier Low / Median / High Price $1,220.89 / $2,249.00 / $2,296.25	Facility		$1,220.89	$2,249.00	$2,296.25
United Facility/Professional Professional Modifier Low / Median / High Price $279.72 / $388.00 / $618.58	Professional		$279.72	$388.00	$618.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $318.50 / $382.12 / $483.70	Professional		$318.50	$382.12	$483.70