Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $147.91 / $186.21	Facility		$114.82	$147.91	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $165.96 / $407.38	Professional		$114.82	$165.96	$407.38
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $169.82 / $676.08 / $676.08	Professional	25	$169.82	$676.08	$676.08
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $123.03 / $123.03 / $123.03	Professional	52	$123.03	$123.03	$123.03
Cigna Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Facility		$199.53	$199.53	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $173.78 / $380.19	Professional		$64.57	$173.78	$380.19
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $169.82 / $251.19	Professional		$125.89	$169.82	$251.19
Medica Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $177.83 / $281.84	Facility		$147.91	$177.83	$281.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $208.93 / $954.99	Professional		$128.82	$208.93	$954.99
Midlands Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $213.80 / $436.52	Professional		$173.78	$213.80	$436.52
Midlands Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Facility		$199.53	$199.53	$199.53
Midlands Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $204.17 / $245.47	Professional		$141.25	$204.17	$245.47
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $741.31 / $741.31 / $776.25	Facility		$741.31	$741.31	$776.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $173.78 / $302.00	Professional		$134.90	$173.78	$302.00
United Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Facility		$125.89	$125.89	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $338.84	Professional		$128.82	$190.55	$338.84
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $194.98 / $245.47	Professional		$158.49	$194.98	$245.47