Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Facility		$213.80	$213.80	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $104.71 / $186.21	Professional		$87.10	$104.71	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $199.53 / $275.42	Professional		$104.71	$199.53	$275.42
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $478.63 / $616.60	Professional		$112.20	$478.63	$616.60
Medica Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $151.36 / $257.04	Facility		$93.33	$151.36	$257.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $181.97 / $1,071.52	Professional		$120.23	$181.97	$1,071.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $229.09 / $302.00	Professional		$165.96	$229.09	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $218.78 / $309.03	Professional		$177.83	$218.78	$309.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $239.88 / $295.12	Professional		$229.09	$239.88	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $151.36 / $263.03	Professional		$114.82	$151.36	$263.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $229.09 / $229.09	Professional		$181.97	$229.09	$229.09