Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $257.04 / $257.04	Facility		$257.04	$257.04	$257.04
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Facility		$151.36	$151.36	$151.36
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $1,258.93 / $1,698.24	Facility		$107.15	$1,258.93	$1,698.24
United Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $134.90 / $162.18	Facility		$107.15	$134.90	$162.18
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