Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $93.33 / $309.03	Facility		$81.28	$93.33	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $83.18 / $138.04	Professional		$81.28	$83.18	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $83.18 / $104.71	Professional		$81.28	$83.18	$104.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $165.96 / $245.47	Professional		$81.28	$165.96	$245.47
Medica Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $91.20 / $138.04	Facility		$81.28	$91.20	$138.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $89.13 / $338.84	Professional		$81.28	$89.13	$338.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $97.72 / $123.03	Professional		$91.20	$97.72	$123.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $100.00	Professional		$95.50	$95.50	$100.00
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $144.54 / $173.78	Professional		$89.13	$144.54	$173.78
United Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $81.28 / $81.28	Facility		$81.28	$81.28	$81.28
United Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $97.72	Professional		$81.28	$81.28	$97.72
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Facility		$89.13	$89.13	$89.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $89.13 / $89.13	Professional		$70.79	$89.13	$89.13