Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $65.81 / $111.64 / $200.69	Facility		$65.81	$111.64	$200.69
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $93.51 / $151.22 / $354.05	Facility	25	$93.51	$151.22	$354.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $82.16 / $194.19	Professional		$49.00	$82.16	$194.19
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $42.14 / $84.96 / $180.00	Professional	25	$42.14	$84.96	$180.00
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $254.64 / $262.68 / $271.76	Professional	50	$254.64	$262.68	$271.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.44 / $116.20 / $176.13	Professional		$58.44	$116.20	$176.13
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $61.17 / $103.36 / $169.17	Professional		$61.17	$103.36	$169.17
Medica Facility/Professional Facility Modifier Low / Median / High Price $58.76 / $93.17 / $144.94	Facility		$58.76	$93.17	$144.94
Medica Facility/Professional Facility Modifier 62 Low / Median / High Price $186.38 / $186.38 / $186.38	Facility	62	$186.38	$186.38	$186.38
Medica Facility/Professional Facility Modifier AS Low / Median / High Price $29.82 / $29.82 / $29.82	Facility	AS	$29.82	$29.82	$29.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $75.09 / $133.43 / $567.54	Professional		$75.09	$133.43	$567.54
Medica Facility/Professional Professional Modifier 25 Low / Median / High Price $100.57 / $145.49 / $207.72	Professional	25	$100.57	$145.49	$207.72
Midlands Facility/Professional Facility Modifier Low / Median / High Price $91.00 / $133.43 / $176.13	Facility		$91.00	$133.43	$176.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $86.18 / $127.78 / $176.13	Professional		$86.18	$127.78	$176.13
Oscar Health Facility/Professional Facility Modifier Low / Median / High Price $83.66 / $90.88 / $945.63	Facility		$83.66	$90.88	$945.63
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.37 / $107.74 / $166.97	Professional		$60.37	$107.74	$166.97
United Facility/Professional Professional Modifier Low / Median / High Price $72.34 / $95.76 / $164.70	Professional		$72.34	$95.76	$164.70
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $79.30 / $102.60 / $130.19	Professional		$79.30	$102.60	$130.19