Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.28 / $204.17 / $295.12	Facility		$81.28	$204.17	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $83.18 / $102.33	Professional		$74.13	$83.18	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $204.17 / $257.04	Professional		$204.17	$204.17	$257.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $144.54 / $194.98	Professional		$91.20	$144.54	$194.98
Medica Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $128.82 / $275.42	Facility		$107.15	$128.82	$275.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $107.15 / $426.58	Professional		$64.57	$107.15	$426.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Professional		$128.82	$128.82	$128.82
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $114.82 / $229.09	Professional		$104.71	$114.82	$229.09
United Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $245.47	Facility		$107.15	$107.15	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $269.15	Professional		$64.57	$64.57	$269.15
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $107.15 / $107.15	Professional		$107.15	$107.15	$107.15