Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $61.66 / $61.66	Facility	26	$43.65	$61.66	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $239.88 / $446.68	Professional		$169.82	$239.88	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $144.54	Professional	26	$52.48	$72.44	$144.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $158.49 / $363.08	Professional	TC	$117.49	$158.49	$363.08
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $446.68 / $562.34	Professional		$354.81	$446.68	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $138.04 / $173.78	Professional	26	$112.20	$138.04	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $309.03 / $389.05	Professional	TC	$245.47	$309.03	$389.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $346.74 / $724.44	Professional		$177.83	$346.74	$724.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $107.15 / $177.83	Professional	26	$63.10	$107.15	$177.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $239.88 / $1,698.24	Professional	TC	$141.25	$239.88	$1,698.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $398.11 / $457.09	Professional		$371.54	$398.11	$457.09
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $125.89 / $147.91	Professional	26	$120.23	$125.89	$147.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $269.15 / $309.03	Professional	TC	$251.19	$269.15	$309.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $416.87	Professional		$416.87	$416.87	$416.87
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	26	$131.83	$131.83	$131.83
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $288.40 / $288.40	Professional	TC	$288.40	$288.40	$288.40
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $338.84 / $562.34	Professional		$239.88	$338.84	$562.34
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $100.00 / $114.82	Professional	26	$74.13	$100.00	$114.82
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $234.42 / $467.74	Professional	TC	$165.96	$234.42	$467.74
United Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $371.54 / $512.86	Professional		$223.87	$371.54	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $107.15 / $138.04	Professional	26	$69.18	$107.15	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $257.04 / $363.08	Professional	TC	$154.88	$257.04	$363.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $426.58 / $426.58	Professional		$363.08	$426.58	$426.58
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $134.90 / $134.90	Professional	26	$114.82	$134.90	$134.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $288.40 / $288.40	Professional	TC	$245.47	$288.40	$288.40