Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.67 / $158.63 / $163.40	Facility		$95.67	$158.63	$163.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.86 / $79.86 / $398.63	Professional		$79.86	$79.86	$398.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.39 / $79.86 / $159.16	Professional		$64.39	$79.86	$159.16
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $79.86 / $96.77 / $442.56	Professional		$79.86	$96.77	$442.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $63.38 / $107.11 / $216.41	Facility		$63.38	$107.11	$216.41
Medica Facility/Professional Professional Modifier Low / Median / High Price $63.38 / $70.56 / $4,956.64	Professional		$63.38	$70.56	$4,956.64
Midlands Facility/Professional Facility Modifier Low / Median / High Price $75.81 / $120.36 / $216.41	Facility		$75.81	$120.36	$216.41
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.81 / $143.41 / $228.48	Professional		$75.81	$143.41	$228.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $79.86 / $160.24 / $278.80	Professional		$79.86	$160.24	$278.80
United Facility/Professional Professional Modifier Low / Median / High Price $79.86 / $83.85 / $111.80	Professional		$79.86	$83.85	$111.80
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $69.36 / $69.36 / $69.36	Facility		$69.36	$69.36	$69.36
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $54.79 / $69.36 / $69.36	Professional		$54.79	$69.36	$69.36