Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.94 / $108.64 / $125.43	Professional		$88.94	$108.64	$125.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.26 / $151.50 / $189.38	Professional		$62.26	$151.50	$189.38
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $110.25 / $129.69 / $147.50	Professional		$110.25	$129.69	$147.50
Medica Facility/Professional Facility Modifier Low / Median / High Price $104.93 / $137.00 / $252.92	Facility		$104.93	$137.00	$252.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $59.83 / $64.70 / $129.41	Professional		$59.83	$64.70	$129.41
Midlands Facility/Professional Facility Modifier Low / Median / High Price $129.16 / $142.66 / $252.92	Facility		$129.16	$142.66	$252.92
Midlands Facility/Professional Professional Modifier Low / Median / High Price $116.84 / $129.16 / $252.92	Professional		$116.84	$129.16	$252.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $129.69 / $133.24 / $237.83	Professional		$129.69	$133.24	$237.83
United Facility/Professional Professional Modifier Low / Median / High Price $50.66 / $64.70 / $82.85	Professional		$50.66	$64.70	$82.85
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $92.22 / $116.73 / $116.73	Professional		$92.22	$116.73	$116.73