Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $316.23	Professional		$102.33	$128.82	$316.23
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $436.52 / $478.63	Professional		$389.05	$436.52	$478.63
Medica Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $208.93 / $891.25	Facility		$117.49	$208.93	$891.25
Medica Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $295.12 / $851.14	Professional		$181.97	$295.12	$851.14
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $323.59	Professional		$169.82	$251.19	$323.59
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $323.59 / $354.81	Professional		$213.80	$323.59	$354.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Professional		$269.15	$269.15	$269.15