Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $347.94 / $461.69 / $2,119.00	Professional		$347.94	$461.69	$2,119.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $291.47 / $394.89 / $913.23	Professional	TC	$291.47	$394.89	$913.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $414.40 / $888.43 / $1,110.53	Professional		$414.40	$888.43	$1,110.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $336.72 / $773.97 / $967.46	Professional	TC	$336.72	$773.97	$967.46
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $344.44 / $485.33 / $1,221.36	Professional		$344.44	$485.33	$1,221.36
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.43 / $81.00 / $186.60	Professional	26	$51.43	$81.00	$186.60
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $261.66 / $416.88 / $1,034.77	Professional	TC	$261.66	$416.88	$1,034.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $324.75 / $798.36 / $2,673.66	Professional		$324.75	$798.36	$2,673.66
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $292.72 / $694.80 / $2,317.40	Professional	TC	$292.72	$694.80	$2,317.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $397.00 / $754.31 / $992.15	Professional		$397.00	$754.31	$992.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.87 / $401.90 / $742.52	Professional		$56.87	$401.90	$742.52
United Facility/Professional Professional Modifier Low / Median / High Price $396.88 / $678.70 / $992.50	Professional		$396.88	$678.70	$992.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $334.11 / $592.94 / $838.11	Professional	TC	$334.11	$592.94	$838.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $659.41 / $834.70 / $982.00	Professional		$659.41	$834.70	$982.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $571.96 / $724.00 / $851.70	Professional	TC	$571.96	$724.00	$851.70