Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $112.20 / $112.20	Facility		$44.67	$112.20	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $38.02 / $114.82	Professional		$23.99	$38.02	$114.82
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $30.90 / $79.43 / $173.78	Professional	25	$30.90	$79.43	$173.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.48 / $35.48 / $35.48	Professional	52	$35.48	$35.48	$35.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $42.66 / $72.44	Professional		$32.36	$42.66	$72.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $52.48 / $114.82	Professional		$23.99	$52.48	$114.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $26.92 / $40.74 / $70.79	Facility		$26.92	$40.74	$70.79
Medica Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $66.07 / $245.47	Professional		$37.15	$66.07	$245.47
Midlands Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $60.26 / $89.13	Professional		$42.66	$60.26	$89.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $70.79 / $104.71	Professional		$34.67	$70.79	$104.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $47.86 / $85.11	Professional		$26.92	$47.86	$85.11
United Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $58.88 / $208.93	Facility		$42.66	$58.88	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $48.98 / $85.11	Professional		$29.51	$48.98	$85.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $63.10 / $89.13	Professional		$52.48	$63.10	$89.13