Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $401.47 / $2,734.53 / $5,091.00	Facility		$401.47	$2,734.53	$5,091.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $118.32 / $200.73 / $373.65	Facility	53	$118.32	$200.73	$373.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $170.41 / $315.70 / $972.45	Professional		$170.41	$315.70	$972.45
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $42.26 / $105.65 / $352.20	Professional	53	$42.26	$105.65	$352.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $953.00 / $953.00 / $953.00	Facility		$953.00	$953.00	$953.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $244.69 / $428.63 / $915.15	Professional		$244.69	$428.63	$915.15
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $132.94 / $244.21 / $425.91	Professional	53	$132.94	$244.21	$425.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $164.67 / $347.36 / $980.05	Professional		$164.67	$347.36	$980.05
Medica Facility/Professional Facility Modifier Low / Median / High Price $238.20 / $491.51 / $1,338.69	Facility		$238.20	$491.51	$1,338.69
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $663.66 / $663.66 / $663.66	Facility	52	$663.66	$663.66	$663.66
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $165.92 / $165.92 / $165.92	Facility	53	$165.92	$165.92	$165.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $358.79 / $642.70 / $1,553.45	Professional		$358.79	$642.70	$1,553.45
Medica Facility/Professional Professional Modifier 53 Low / Median / High Price $134.09 / $134.09 / $134.09	Professional	53	$134.09	$134.09	$134.09
Midlands Facility/Professional Facility Modifier Low / Median / High Price $295.60 / $587.03 / $924.50	Facility		$295.60	$587.03	$924.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.60 / $491.51 / $788.05	Professional		$295.60	$491.51	$788.05
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $502.04 / $502.04 / $502.04	Facility		$502.04	$502.04	$502.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $147.10 / $308.10 / $710.20	Professional		$147.10	$308.10	$710.20
United Facility/Professional Facility Modifier Low / Median / High Price $1,321.00 / $1,835.00 / $4,006.00	Facility		$1,321.00	$1,835.00	$4,006.00
United Facility/Professional Professional Modifier Low / Median / High Price $343.19 / $566.36 / $1,015.62	Professional		$343.19	$566.36	$1,015.62
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $351.70 / $430.30 / $764.80	Professional		$351.70	$430.30	$764.80