Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.26 / $115.84 / $138.38	Professional		$79.26	$115.84	$138.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.58 / $60.74 / $78.02	Professional	TC	$40.58	$60.74	$78.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.00 / $222.41 / $255.81	Professional		$129.00	$222.41	$255.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.00 / $105.14 / $135.71	Professional	TC	$51.00	$105.14	$135.71
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $79.34 / $116.29 / $423.20	Professional		$79.34	$116.29	$423.20
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.88 / $66.51 / $210.32	Professional	26	$41.88	$66.51	$210.32
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.47 / $55.40 / $212.88	Professional	TC	$37.47	$55.40	$212.88
Medica Facility/Professional Professional Modifier Low / Median / High Price $107.33 / $220.65 / $646.83	Professional		$107.33	$220.65	$646.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $50.39 / $105.82 / $354.71	Professional	TC	$50.39	$105.82	$354.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $118.05 / $199.44 / $245.94	Professional		$118.05	$199.44	$245.94
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.87 / $80.56 / $159.87	Professional		$42.87	$80.56	$159.87
United Facility/Professional Professional Modifier Low / Median / High Price $102.66 / $187.19 / $253.85	Professional		$102.66	$187.19	$253.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.39 / $73.30 / $123.23	Professional	TC	$50.39	$73.30	$123.23
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $140.22 / $177.50 / $208.80	Professional		$140.22	$177.50	$208.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $69.59 / $88.10 / $103.60	Professional	TC	$69.59	$88.10	$103.60