Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $776.25 / $1,380.38	Facility		$691.83	$776.25	$1,380.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $691.83 / $1,174.90	Professional		$691.83	$691.83	$1,174.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $691.83 / $870.96	Professional		$691.83	$691.83	$870.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $691.83 / $1,258.93	Professional		$588.84	$691.83	$1,258.93
Medica Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $776.25 / $1,174.90	Facility		$691.83	$776.25	$1,174.90
Medica Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $758.58 / $2,818.38	Professional		$691.83	$758.58	$2,818.38
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $831.76 / $1,023.29	Professional		$776.25	$831.76	$1,023.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $776.25 / $1,023.29	Professional		$776.25	$776.25	$1,023.29
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,230.27 / $1,445.44	Professional		$741.31	$1,230.27	$1,445.44
United Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $691.83 / $691.83	Facility		$691.83	$691.83	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $691.83 / $812.83	Professional		$691.83	$691.83	$812.83
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $758.58 / $758.58	Facility		$758.58	$758.58	$758.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $758.58 / $758.58	Professional		$588.84	$758.58	$758.58