Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $173.00 / $173.00 / $173.00	Facility		$173.00	$173.00	$173.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.00 / $173.00 / $173.00	Professional		$173.00	$173.00	$173.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $263.02 / $263.02 / $263.02	Facility		$263.02	$263.02	$263.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.02 / $263.02 / $270.92	Professional		$263.02	$263.02	$270.92
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $178.32 / $183.40 / $196.17	Professional		$178.32	$183.40	$196.17
Medica Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $173.00 / $294.10	Facility		$100.00	$173.00	$294.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $49.43 / $1,266.63 / $1,266.63	Professional		$49.43	$1,266.63	$1,266.63
Midlands Facility/Professional Facility Modifier Low / Median / High Price $1,266.63 / $1,266.63 / $1,266.63	Facility		$1,266.63	$1,266.63	$1,266.63
Midlands Facility/Professional Professional Modifier Low / Median / High Price $51.28 / $51.28 / $1,266.63	Professional		$51.28	$51.28	$1,266.63
United Facility/Professional Professional Modifier Low / Median / High Price $353.50 / $353.50 / $353.50	Professional		$353.50	$353.50	$353.50
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $1,038.08 / $1,038.08 / $1,038.08	Facility		$1,038.08	$1,038.08	$1,038.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $820.08 / $1,038.08 / $1,038.08	Professional		$820.08	$1,038.08	$1,038.08