Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $135.61 / $168.97 / $288.00	Facility		$135.61	$168.97	$288.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.37 / $69.37 / $317.57	Professional		$69.37	$69.37	$317.57
Cigna Facility/Professional Facility Modifier Low / Median / High Price $83.11 / $83.11 / $83.11	Facility		$83.11	$83.11	$83.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.37 / $75.30 / $94.13	Professional		$69.37	$75.30	$94.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $53.23 / $69.37 / $212.80	Professional		$53.23	$69.37	$212.80
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.48 / $88.69 / $123.42	Facility		$77.48	$88.69	$123.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.48 / $85.24 / $317.82	Professional		$77.48	$85.24	$317.82
Midlands Facility/Professional Facility Modifier Low / Median / High Price $66.51 / $92.99 / $129.56	Facility		$66.51	$92.99	$129.56
Midlands Facility/Professional Professional Modifier Low / Median / High Price $56.71 / $89.77 / $107.97	Professional		$56.71	$89.77	$107.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.37 / $137.47 / $144.91	Professional		$69.37	$137.47	$144.91
United Facility/Professional Professional Modifier Low / Median / High Price $69.37 / $71.45 / $87.26	Professional		$69.37	$71.45	$87.26
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $77.48 / $77.48 / $77.48	Facility		$77.48	$77.48	$77.48
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $61.22 / $77.48 / $77.48	Professional		$61.22	$77.48	$77.48