Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $257.04 / $338.84	Facility		$190.55	$257.04	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $162.18 / $467.74	Professional		$107.15	$162.18	$467.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $194.98 / $389.05	Professional		$114.82	$194.98	$389.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $213.80 / $389.05	Professional		$117.49	$213.80	$389.05
Medica Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $165.96 / $281.84	Facility		$102.33	$165.96	$281.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $239.88 / $1,023.29	Professional		$151.36	$239.88	$1,023.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $380.19	Professional		$169.82	$251.19	$380.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $239.88 / $436.52	Professional		$151.36	$239.88	$436.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $371.54	Professional		$190.55	$281.84	$371.54
United Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $190.55	Facility		$151.36	$151.36	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $173.78 / $302.00	Professional		$123.03	$173.78	$302.00
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 $177.83 / $218.78 / $281.84	Professional		$177.83	$218.78	$281.84