Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.30 / $176.50 / $356.85	Professional		$109.30	$176.50	$356.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.29 / $146.37 / $293.89	Professional	TC	$87.29	$146.37	$293.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $175.94 / $374.77 / $468.47	Professional		$175.94	$374.77	$468.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.42 / $318.94 / $398.68	Professional	TC	$124.42	$318.94	$398.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $135.24 / $204.14 / $603.67	Professional		$135.24	$204.14	$603.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $24.87 / $40.26 / $123.34	Professional	26	$24.87	$40.26	$123.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.47 / $166.80 / $480.34	Professional	TC	$107.47	$166.80	$480.34
Medica Facility/Professional Professional Modifier Low / Median / High Price $136.06 / $296.86 / $964.87	Professional		$136.06	$296.86	$964.87
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $106.72 / $232.85 / $798.40	Professional	TC	$106.72	$232.85	$798.40
Midlands Facility/Professional Professional Modifier Low / Median / High Price $147.00 / $300.35 / $437.51	Professional		$147.00	$300.35	$437.51
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $27.04 / $158.50 / $309.66	Professional		$27.04	$158.50	$309.66
United Facility/Professional Professional Modifier Low / Median / High Price $136.06 / $254.63 / $336.43	Professional		$136.06	$254.63	$336.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.72 / $203.74 / $263.89	Professional	TC	$106.72	$203.74	$263.89
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $278.87 / $353.00 / $415.30	Professional		$278.87	$353.00	$415.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $236.68 / $299.60 / $352.50	Professional	TC	$236.68	$299.60	$352.50