Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $97.72 / $173.78	Facility		$87.10	$97.72	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $147.91	Professional		$87.10	$87.10	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $89.13 / $141.25	Professional		$87.10	$89.13	$141.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $218.78 / $323.59	Professional		$85.11	$218.78	$323.59
Medica Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $95.50 / $181.97	Facility		$85.11	$95.50	$181.97
Medica Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $93.33 / $512.86	Professional		$85.11	$93.33	$512.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $141.25 / $181.97	Professional		$125.89	$141.25	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $151.36 / $416.87	Professional		$141.25	$151.36	$416.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $154.88 / $186.21	Professional		$93.33	$154.88	$186.21
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 $87.10 / $89.13 / $114.82	Professional		$87.10	$89.13	$114.82
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Facility		$93.33	$93.33	$93.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $93.33 / $93.33	Professional		$72.44	$93.33	$93.33