Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $53.70 / $53.70	Facility	26	$38.90	$53.70	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $457.09	Professional		$169.82	$234.42	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $204.17	Professional	26	$51.29	$75.86	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $354.81	Professional	TC	$120.23	$177.83	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $436.52 / $549.54	Professional		$354.81	$436.52	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $125.89 / $154.88	Professional	26	$100.00	$125.89	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $316.23 / $398.11	Professional	TC	$251.19	$316.23	$398.11
Medica Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $407.38 / $794.33	Professional		$234.42	$407.38	$794.33
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $102.33 / $562.34	Professional	26	$67.61	$102.33	$562.34
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $316.23 / $1,548.82	Professional	TC	$199.53	$316.23	$1,548.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $389.05 / $602.56	Professional		$363.08	$389.05	$602.56
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $112.20 / $162.18	Professional	26	$107.15	$112.20	$162.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $275.42 / $436.52	Professional	TC	$257.04	$275.42	$436.52
Midlands Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Professional		$457.09	$457.09	$457.09
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Professional	26	$117.49	$117.49	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $338.84	Professional	TC	$338.84	$338.84	$338.84
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $354.81 / $537.03	Professional		$245.47	$354.81	$537.03
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $97.72 / $114.82	Professional	26	$69.18	$97.72	$114.82
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $251.19 / $446.68	Professional	TC	$173.78	$251.19	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $416.87 / $602.56	Professional		$223.87	$416.87	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $104.71 / $147.91	Professional	26	$63.10	$104.71	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $316.23 / $457.09	Professional	TC	$158.49	$316.23	$457.09
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $416.87 / $416.87	Professional		$354.81	$416.87	$416.87
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $120.23	Professional	26	$102.33	$120.23	$120.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $295.12 / $295.12	Professional	TC	$251.19	$295.12	$295.12