Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $346.74 / $2,691.53 / $5,011.87	Facility		$346.74	$2,691.53	$5,011.87
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $75.86 / $194.98 / $389.05	Facility	53	$75.86	$194.98	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $323.59 / $1,659.59	Professional		$169.82	$323.59	$1,659.59
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $61.66 / $131.83 / $302.00	Professional	53	$61.66	$131.83	$302.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $630.96	Professional		$199.53	$371.54	$630.96
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $131.83 / $229.09 / $436.52	Professional	53	$131.83	$229.09	$436.52
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $575.44 / $1,071.52	Professional		$165.96	$575.44	$1,071.52
Medica Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $457.09 / $1,995.26	Facility		$208.93	$457.09	$1,995.26
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	52	$660.69	$660.69	$660.69
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $165.96 / $165.96 / $165.96	Facility	53	$165.96	$165.96	$165.96
Medica Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $616.60 / $2,187.76	Professional		$338.84	$616.60	$2,187.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $489.78 / $912.01	Professional		$295.12	$489.78	$912.01
Midlands Facility/Professional Professional Modifier 53 Low / Median / High Price $147.91 / $245.47 / $436.52	Professional	53	$147.91	$245.47	$436.52
Midlands Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $616.60 / $933.25	Professional		$426.58	$616.60	$933.25
Midlands Facility/Professional Professional Modifier 53 Low / Median / High Price $100.00 / $245.47 / $467.74	Professional	53	$100.00	$245.47	$467.74
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $501.19 / $501.19	Facility		$501.19	$501.19	$501.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $316.23 / $707.95	Professional		$97.72	$316.23	$707.95
United Facility/Professional Facility Modifier Low / Median / High Price $1,318.26 / $2,137.96 / $4,073.80	Facility		$1,318.26	$2,137.96	$4,073.80
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $407.38 / $794.33	Professional		$213.80	$407.38	$794.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $426.58 / $758.58	Professional		$354.81	$426.58	$758.58