Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $891.25 / $1,096.48	Facility		$891.25	$891.25	$1,096.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $794.33 / $1,445.44	Professional		$602.56	$794.33	$1,445.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,023.29 / $1,584.89	Facility		$1,023.29	$1,023.29	$1,584.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,819.70 / $2,238.72	Professional		$1,023.29	$1,819.70	$2,238.72
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,412.54 / $1,548.82	Professional		$1,318.26	$1,412.54	$1,548.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $977.24 / $1,698.24 / $6,606.93	Facility		$977.24	$1,698.24	$6,606.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $870.96 / $2,398.83	Professional		$630.96	$870.96	$2,398.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $1,621.81 / $1,905.46	Professional		$1,548.82	$1,621.81	$1,905.46
Midlands Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Facility		$1,584.89	$1,584.89	$1,584.89
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $2,398.83 / $2,398.83	Professional		$1,445.44	$2,398.83	$2,398.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $2,041.74 / $3,090.30	Professional		$1,445.44	$2,041.74	$3,090.30
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,047.13 / $2,041.74	Facility		$489.78	$1,047.13	$2,041.74
United Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $707.95 / $1,318.26	Professional		$630.96	$707.95	$1,318.26
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,412.54 / $1,412.54	Professional		$1,096.48	$1,412.54	$1,412.54