Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $223.87 / $389.05	Facility		$194.98	$223.87	$389.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $199.53 / $323.59	Professional		$194.98	$199.53	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $199.53 / $251.19	Professional		$194.98	$199.53	$251.19
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $346.74 / $512.86	Professional		$190.55	$346.74	$512.86
Medica Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $208.93 / $323.59	Facility		$190.55	$208.93	$323.59
Medica Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $208.93 / $794.33	Professional		$190.55	$208.93	$794.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $234.42 / $288.40	Professional		$208.93	$234.42	$288.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $223.87 / $630.96	Professional		$208.93	$223.87	$630.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $346.74 / $416.87	Professional		$213.80	$346.74	$416.87
United Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $194.98 / $194.98	Facility		$194.98	$194.98	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $194.98 / $234.42	Professional		$194.98	$194.98	$234.42
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $208.93 / $208.93	Facility		$208.93	$208.93	$208.93
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $208.93 / $208.93	Professional		$162.18	$208.93	$208.93