Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $603.00 / $3,014.11 / $4,964.00	Facility		$603.00	$3,014.11	$4,964.00
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $196.84 / $201.09 / $373.99	Facility	53	$196.84	$201.09	$373.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.10 / $345.91 / $974.54	Professional		$180.10	$345.91	$974.54
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $42.30 / $105.84 / $286.33	Professional	53	$42.30	$105.84	$286.33
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 / $428.83 / $901.95	Professional		$244.69	$428.83	$901.95
Cigna Facility/Professional Professional Modifier 53 Low / Median / High Price $133.43 / $244.40 / $425.91	Professional	53	$133.43	$244.40	$425.91
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $164.82 / $348.01 / $1,018.80	Professional		$164.82	$348.01	$1,018.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $238.54 / $491.99 / $1,421.62	Facility		$238.54	$491.99	$1,421.62
Medica Facility/Professional Facility Modifier 52 Low / Median / High Price $664.86 / $664.86 / $664.86	Facility	52	$664.86	$664.86	$664.86
Medica Facility/Professional Facility Modifier 53 Low / Median / High Price $166.21 / $166.21 / $166.21	Facility	53	$166.21	$166.21	$166.21
Medica Facility/Professional Professional Modifier Low / Median / High Price $359.15 / $643.34 / $1,553.45	Professional		$359.15	$643.34	$1,553.45
Midlands Facility/Professional Facility Modifier Low / Median / High Price $295.76 / $587.58 / $924.50	Facility		$295.76	$587.58	$924.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $295.76 / $491.99 / $776.80	Professional		$295.76	$491.99	$776.80
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $454.69 / $868.80 / $2,476.08	Facility		$454.69	$868.80	$2,476.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $147.37 / $309.38 / $711.55	Professional		$147.37	$309.38	$711.55
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 $348.19 / $606.00 / $1,158.63	Professional		$348.19	$606.00	$1,158.63
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $352.30 / $431.10 / $765.60	Professional		$352.30	$431.10	$765.60