Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Facility		$138.04	$138.04	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $173.78	Professional		$138.04	$138.04	$173.78
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 $131.83 / $138.04 / $162.18	Professional		$131.83	$138.04	$162.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $186.21 / $389.05	Professional		$138.04	$186.21	$389.05
Medica Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $154.88 / $302.00	Facility		$109.65	$154.88	$302.00
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $302.00	Professional		$109.65	$109.65	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $158.49 / $302.00	Professional		$131.83	$158.49	$302.00
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 $194.98 / $194.98 / $194.98	Professional		$194.98	$194.98	$194.98
United Facility/Professional Facility Modifier Low / Median / High Price $0.13 / $128.82 / $208.93	Facility		$0.13	$128.82	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $138.04 / $302.00	Professional		$125.89	$138.04	$302.00
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Facility		$138.04	$138.04	$138.04
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04