Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.56 / $90.09 / $96.84	Professional		$55.56	$90.09	$96.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.62 / $133.88 / $167.34	Professional		$51.62	$133.88	$167.34
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $92.49 / $107.55 / $138.06	Professional		$92.49	$107.55	$138.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $87.01 / $114.84 / $209.72	Facility		$87.01	$114.84	$209.72
Medica Facility/Professional Professional Modifier Low / Median / High Price $49.61 / $53.66 / $107.32	Professional		$49.61	$53.66	$107.32
Midlands Facility/Professional Facility Modifier Low / Median / High Price $107.11 / $118.31 / $209.72	Facility		$107.11	$118.31	$209.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.30 / $107.11 / $209.72	Professional		$95.30	$107.11	$209.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $117.92 / $210.49	Professional		$50.00	$117.92	$210.49
United Facility/Professional Professional Modifier Low / Median / High Price $42.85 / $53.66 / $78.70	Professional		$42.85	$53.66	$78.70
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $76.47 / $96.80 / $96.80	Professional		$76.47	$96.80	$96.80