Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $54.95 / $54.95	Facility		$54.95	$54.95	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $57.54 / $58.88	Professional		$54.95	$57.54	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $72.44	Professional		$58.88	$58.88	$72.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $85.11 / $151.36	Professional		$50.12	$85.11	$151.36
Medica Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $69.18 / $128.82	Facility		$54.95	$69.18	$128.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $69.18 / $120.23	Professional		$69.18	$69.18	$120.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Professional		$83.18	$83.18	$83.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $83.18 / $83.18	Professional		$83.18	$83.18	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $0.07 / $69.18 / $114.82	Facility		$0.07	$69.18	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $69.18 / $70.79	Professional		$69.18	$69.18	$70.79
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $69.18 / $69.18	Facility		$69.18	$69.18	$69.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $69.18 / $69.18	Professional		$69.18	$69.18	$69.18