Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Hally Health Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $150.00 / $150.00	Facility		$150.00	$150.00	$150.00
Medica Facility/Professional Facility Modifier Low / Median / High Price $794.39 / $794.39 / $794.39	Facility		$794.39	$794.39	$794.39
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $1,463.40 / $2,926.80 / $4,170.68	Facility		$1,463.40	$2,926.80	$4,170.68
Wellmark Facility/Professional Facility Modifier Low / Median / High Price $18,170.00 / $28,440.00 / $40,290.00	Facility		$18,170.00	$28,440.00	$40,290.00