Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $128.82 / $218.78	Facility		$67.61	$128.82	$218.78
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $138.04 / $138.04 / $213.80	Facility	25	$138.04	$138.04	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $114.82 / $302.00	Professional		$66.07	$114.82	$302.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $70.79 / $131.83 / $309.03	Professional	25	$70.79	$131.83	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $134.90 / $257.04	Professional		$77.62	$134.90	$257.04
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $134.90 / $239.88	Professional		$77.62	$134.90	$239.88
Medica Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $104.71 / $199.53	Facility		$69.18	$104.71	$199.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $165.96 / $691.83	Professional		$102.33	$165.96	$691.83
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $83.18 / $173.78 / $309.03	Professional	25	$83.18	$173.78	$309.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $181.97 / $245.47	Professional		$134.90	$181.97	$245.47
Midlands Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $190.55 / $295.12	Professional		$109.65	$190.55	$295.12
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $109.65 / $912.01	Facility		$109.65	$109.65	$912.01
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $134.90 / $245.47	Professional		$75.86	$134.90	$245.47
United Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $128.82	Facility		$93.33	$93.33	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $112.20 / $190.55	Professional		$75.86	$112.20	$190.55
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $128.82 / $158.49	Professional		$97.72	$128.82	$158.49