Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $158.49 / $389.05	Facility		$104.71	$158.49	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $213.80	Professional		$104.71	$104.71	$213.80
Cigna Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $120.23 / $120.23	Facility		$120.23	$120.23	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $107.15 / $134.90	Professional		$104.71	$107.15	$134.90
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $144.54 / $213.80	Professional		$100.00	$144.54	$213.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $112.20 / $169.82	Facility		$100.00	$112.20	$169.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $112.20 / $426.58	Professional		$100.00	$112.20	$426.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $125.89 / $151.36	Professional		$117.49	$125.89	$151.36
Midlands Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $169.82 / $223.87	Professional		$120.23	$169.82	$223.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $186.21 / $223.87	Professional		$114.82	$186.21	$223.87
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $125.89	Professional		$104.71	$104.71	$125.89
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Facility		$109.65	$109.65	$109.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $109.65 / $109.65	Professional		$87.10	$109.65	$109.65