Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Facility		$151.36	$151.36	$151.36
Medica Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $288.40 / $1,819.70	Facility		$57.54	$288.40	$1,819.70
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $3,311.31 / $6,025.60 / $16,982.44	Facility		$3,311.31	$6,025.60	$16,982.44
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $18,197.01 / $28,183.83 / $40,738.03	Facility		$18,197.01	$28,183.83	$40,738.03