Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $54.95 / $54.95	Facility		$30.20	$54.95	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $30.90 / $79.43	Professional		$30.20	$30.90	$79.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $223.87 / $269.15	Facility		$67.61	$223.87	$269.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $36.31 / $42.66	Professional		$30.20	$36.31	$42.66
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $34.67 / $75.86	Professional		$25.70	$34.67	$75.86
Medica Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $42.66 / $67.61	Facility		$30.20	$42.66	$67.61
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $30.20 / $64.57	Professional		$30.20	$30.20	$64.57
Midlands Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $39.81 / $46.77	Professional		$36.31	$39.81	$46.77
Midlands Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $208.93 / $269.15	Facility		$63.10	$208.93	$269.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $64.57 / $79.43	Professional		$50.12	$64.57	$79.43
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $69.18 / $83.18	Professional		$56.23	$69.18	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $0.03 / $30.20 / $50.12	Facility		$0.03	$30.20	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $53.70 / $125.89	Professional		$45.71	$53.70	$125.89
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $30.20 / $30.20	Facility		$30.20	$30.20	$30.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $30.20 / $30.20	Professional		$30.20	$30.20	$30.20