Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Facility		$77.62	$77.62	$77.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $97.72	Professional		$77.62	$77.62	$97.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $245.47 / $302.00	Facility		$190.55	$245.47	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $85.11 / $104.71	Professional		$77.62	$85.11	$104.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $89.13 / $151.36	Professional		$58.88	$89.13	$151.36
Medica Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $102.33 / $380.19	Facility		$85.11	$102.33	$380.19
Medica Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $128.82	Professional		$85.11	$85.11	$128.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $102.33 / $128.82	Professional		$89.13	$102.33	$128.82
Midlands Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $257.04 / $302.00	Facility		$204.17	$257.04	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Professional		$89.13	$89.13	$89.13
United Facility/Professional Facility Modifier Low / Median / High Price $0.08 / $83.18 / $138.04	Facility		$0.08	$83.18	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $95.50 / $125.89	Professional		$77.62	$95.50	$125.89
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Facility		$77.62	$77.62	$77.62
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62