Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $1,258.93 / $1,258.93	Facility		$204.17	$1,258.93	$1,258.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $1,258.93	Professional		$204.17	$204.17	$1,258.93
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 $204.17 / $269.15 / $338.84	Professional		$204.17	$269.15	$338.84
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $407.38 / $831.76	Professional		$173.78	$407.38	$831.76
Medica Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $363.08 / $1,258.93	Facility		$234.42	$363.08	$1,258.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $234.42 / $758.58	Professional		$234.42	$234.42	$758.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $338.84 / $758.58	Professional		$281.84	$338.84	$758.58
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 $549.54 / $549.54 / $549.54	Professional		$549.54	$549.54	$549.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $223.87 / $1,202.26	Professional		$186.21	$223.87	$1,202.26
United Facility/Professional Facility Modifier Low / Median / High Price $0.26 / $263.03 / $436.52	Facility		$0.26	$263.03	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $263.03 / $1,047.13	Professional		$125.89	$263.03	$1,047.13
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Facility		$204.17	$204.17	$204.17
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $204.17	Professional		$204.17	$204.17	$204.17