Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Facility		$549.54	$549.54	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $1,000.00	Professional		$549.54	$549.54	$1,000.00
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 $549.54 / $1,122.02 / $1,445.44	Professional		$549.54	$1,122.02	$1,445.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $616.60 / $1,258.93	Professional		$275.42	$616.60	$1,258.93
Medica Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $2,818.38 / $4,365.16	Facility		$1,479.11	$2,818.38	$4,365.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $2,818.38 / $3,890.45	Professional		$2,691.53	$2,818.38	$3,890.45
Midlands Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $3,388.44 / $4,265.80	Professional		$162.18	$3,388.44	$4,265.80
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 $162.18 / $162.18 / $162.18	Professional		$162.18	$162.18	$162.18
United Facility/Professional Facility Modifier Low / Median / High Price $2.82 / $2,818.38 / $4,570.88	Facility		$2.82	$2,818.38	$4,570.88
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $2,454.71 / $2,754.23	Professional		$125.89	$2,454.71	$2,754.23
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Facility		$549.54	$549.54	$549.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Professional		$549.54	$549.54	$549.54