Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $107.15 / $162.18	Facility		$81.28	$107.15	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $87.10 / $9,772.37	Professional		$81.28	$87.10	$9,772.37
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 $67.61 / $123.03 / $169.82	Professional		$67.61	$123.03	$169.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $87.10 / $131.83	Facility		$77.62	$87.10	$131.83
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $87.10 / $6,165.95	Professional		$77.62	$87.10	$6,165.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $97.72 / $117.49	Professional		$89.13	$97.72	$117.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $123.03 / $165.96	Professional		$89.13	$123.03	$165.96
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 $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $87.10 / $87.10	Professional		$67.61	$87.10	$87.10