Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $380.19 / $1,023.29	Professional		$338.84	$380.19	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $107.15 / $131.83	Professional	26	$97.72	$107.15	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $269.15 / $331.13	Professional	TC	$239.88	$269.15	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $812.83 / $1,023.29	Professional		$758.58	$812.83	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $229.09 / $239.88 / $302.00	Professional	26	$229.09	$239.88	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $512.86 / $575.44 / $724.44	Professional	TC	$512.86	$575.44	$724.44
Medica Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $630.96 / $2,691.53	Professional		$323.59	$630.96	$2,691.53
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $190.55 / $794.33	Professional	26	$117.49	$190.55	$794.33
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $416.87 / $1,905.46	Professional	TC	$208.93	$416.87	$1,905.46
Midlands Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $741.31 / $758.58	Professional		$645.65	$741.31	$758.58
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $223.87 / $229.09 / $251.19	Professional	26	$223.87	$229.09	$251.19
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $501.19 / $512.86	Professional	TC	$416.87	$501.19	$512.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Professional		$645.65	$645.65	$645.65
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $223.87 / $223.87 / $223.87	Professional	26	$223.87	$223.87	$223.87
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $416.87 / $416.87 / $416.87	Professional	TC	$416.87	$416.87	$416.87
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $575.44 / $660.69	Professional		$457.09	$575.44	$660.69
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $181.97 / $204.17	Professional	26	$134.90	$181.97	$204.17
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $398.11 / $457.09	Professional	TC	$295.12	$398.11	$457.09
United Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $630.96 / $954.99	Professional		$346.74	$630.96	$954.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $208.93 / $295.12	Professional	26	$120.23	$208.93	$295.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $436.52 / $676.08	Professional	TC	$229.09	$436.52	$676.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $776.25 / $794.33	Professional		$660.69	$776.25	$794.33
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $234.42 / $245.47	Professional	26	$199.53	$234.42	$245.47
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $537.03 / $549.54	Professional	TC	$457.09	$537.03	$549.54