Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $199.53 / $269.15	Facility		$151.36	$199.53	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $162.18 / $436.52	Professional		$89.13	$162.18	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $154.88 / $309.03	Professional		$89.13	$154.88	$309.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $173.78 / $302.00	Professional		$91.20	$173.78	$302.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $131.83 / $218.78	Facility		$81.28	$131.83	$218.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $181.97 / $812.83	Professional		$117.49	$181.97	$812.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $302.00	Professional		$131.83	$190.55	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $181.97 / $346.74	Professional		$117.49	$181.97	$346.74
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $67.61 / $67.61	Facility		$67.61	$67.61	$67.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $281.84	Professional		$147.91	$186.21	$281.84
United Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $114.82 / $151.36	Facility		$114.82	$114.82	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $134.90 / $239.88	Professional		$93.33	$134.90	$239.88
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Facility		$54.95	$54.95	$54.95
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $165.96 / $223.87	Professional		$134.90	$165.96	$223.87