Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $165.96 / $229.09	Facility		$104.71	$165.96	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $1,949.84	Professional		$104.71	$120.23	$1,949.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $107.15 / $138.04	Professional		$104.71	$107.15	$138.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $467.74 / $1,380.38	Professional		$109.65	$467.74	$1,380.38
Medica Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $165.96 / $446.68	Facility		$109.65	$165.96	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $123.03 / $1,698.24	Professional		$109.65	$123.03	$1,698.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $229.09	Professional		$131.83	$177.83	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $776.25 / $794.33	Professional		$138.04	$776.25	$794.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $154.88 / $223.87	Professional		$77.62	$154.88	$223.87
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Facility		$104.71	$104.71	$104.71
United Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $107.15 / $144.54	Professional		$104.71	$107.15	$144.54
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Facility		$117.49	$117.49	$117.49
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $117.49 / $117.49	Professional		$93.33	$117.49	$117.49