Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $19.95 / $19.95	Facility	26	$19.95	$19.95	$19.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $117.49 / $229.09	Professional		$87.10	$117.49	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.92 / $69.18	Professional	26	$19.05	$26.92	$69.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $83.18 / $190.55	Professional	TC	$64.57	$83.18	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $234.42 / $295.12	Professional		$190.55	$234.42	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $46.77 / $58.88	Professional	26	$37.15	$46.77	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $190.55 / $234.42	Professional	TC	$147.91	$190.55	$234.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $120.23 / $204.17	Professional		$89.13	$120.23	$204.17
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $30.90 / $57.54	Professional	26	$20.42	$30.90	$57.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $91.20 / $173.78	Professional	TC	$61.66	$91.20	$173.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $199.53 / $208.93	Professional		$190.55	$199.53	$208.93
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $42.66 / $48.98	Professional	26	$39.81	$42.66	$48.98
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $151.36 / $165.96	Professional	TC	$147.91	$151.36	$165.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $190.55	Professional		$190.55	$190.55	$190.55
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $42.66 / $42.66	Professional	26	$42.66	$42.66	$42.66
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	TC	$147.91	$147.91	$147.91
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $158.49 / $190.55	Professional		$100.00	$158.49	$190.55
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.88 / $38.90	Professional	26	$23.44	$33.88	$38.90
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $128.82 / $151.36	Professional	TC	$83.18	$128.82	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $138.04 / $208.93	Professional		$91.20	$138.04	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $32.36 / $43.65	Professional	26	$22.39	$32.36	$43.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $102.33 / $169.82	Professional	TC	$67.61	$102.33	$169.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $199.53 / $199.53	Professional		$169.82	$199.53	$199.53
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $40.74 / $40.74	Professional	26	$34.67	$40.74	$40.74
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $158.49 / $158.49	Professional	TC	$134.90	$158.49	$158.49