Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $96.97 / $96.97 / $111.22	Facility		$96.97	$96.97	$111.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.99 / $87.67 / $166.19	Professional		$62.99	$87.67	$166.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $90.28 / $90.28 / $153.52	Facility		$90.28	$90.28	$153.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $90.28 / $161.63 / $202.03	Professional		$90.28	$161.63	$202.03
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $119.61 / $129.62 / $139.56	Professional		$119.61	$129.62	$139.56
Medica Facility/Professional Facility Modifier Low / Median / High Price $87.67 / $179.32 / $703.87	Facility		$87.67	$179.32	$703.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $66.72 / $78.66 / $190.68	Professional		$66.72	$78.66	$190.68
Midlands Facility/Professional Facility Modifier Low / Median / High Price $153.05 / $153.52 / $212.00	Facility		$153.05	$153.52	$212.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $130.33 / $180.66 / $293.33	Professional		$130.33	$180.66	$293.33
United Facility/Professional Professional Modifier Low / Median / High Price $66.72 / $69.62 / $181.43	Professional		$66.72	$69.62	$181.43
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $136.77 / $136.77 / $136.77	Facility		$136.77	$136.77	$136.77
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $108.05 / $136.77 / $136.77	Professional		$108.05	$136.77	$136.77