Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $133.13 / $133.13 / $228.04	Facility		$133.13	$133.13	$228.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $89.34 / $308.27	Professional		$89.34	$89.34	$308.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $120.98 / $182.87	Professional		$89.34	$120.98	$182.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $94.06 / $302.02	Professional		$89.34	$94.06	$302.02
Medica Facility/Professional Facility Modifier Low / Median / High Price $104.58 / $133.13 / $209.11	Facility		$104.58	$133.13	$209.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $104.58 / $116.42 / $1,160.52	Professional		$104.58	$116.42	$1,160.52
Midlands Facility/Professional Facility Modifier Low / Median / High Price $142.50 / $199.98 / $261.33	Facility		$142.50	$199.98	$261.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $135.58 / $166.28 / $219.12	Professional		$135.58	$166.28	$219.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $177.34 / $216.10	Professional		$89.34	$177.34	$216.10
United Facility/Professional Professional Modifier Low / Median / High Price $89.34 / $92.02 / $107.21	Professional		$89.34	$92.02	$107.21
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $114.45 / $114.45 / $114.45	Facility		$114.45	$114.45	$114.45
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $90.42 / $114.45 / $114.45	Professional		$90.42	$114.45	$114.45