Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $239.88 / $316.23	Facility		$173.78	$239.88	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $199.53 / $512.86	Professional		$107.15	$199.53	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $363.08	Professional		$107.15	$181.97	$363.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $199.53 / $338.84	Professional		$109.65	$199.53	$338.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $151.36 / $257.04	Facility		$95.50	$151.36	$257.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $218.78 / $954.99	Professional		$138.04	$218.78	$954.99
Midlands Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $234.42 / $354.81	Professional		$158.49	$234.42	$354.81
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $223.87 / $398.11	Professional		$141.25	$223.87	$398.11
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $141.25 / $870.96	Facility		$141.25	$141.25	$870.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $331.13	Professional		$177.83	$229.09	$331.13
United Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $177.83	Facility		$138.04	$138.04	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $158.49 / $275.42	Professional		$109.65	$158.49	$275.42
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 $162.18 / $199.53 / $257.04	Professional		$162.18	$199.53	$257.04