Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $28.18 / $28.18	Facility	26	$28.18	$28.18	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $131.83 / $234.42	Professional		$112.20	$131.83	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $30.90 / $100.00	Professional	26	$25.70	$30.90	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $104.71 / $154.88	Professional	TC	$85.11	$104.71	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $302.00 / $371.54	Professional		$239.88	$302.00	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $81.28	Professional	26	$51.29	$64.57	$81.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $234.42 / $295.12	Professional	TC	$190.55	$234.42	$295.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $151.36 / $288.40	Professional		$107.15	$151.36	$288.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $44.67 / $199.53	Professional	26	$27.54	$44.67	$199.53
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $117.49 / $691.83	Professional	TC	$81.28	$117.49	$691.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $269.15	Professional		$251.19	$251.19	$269.15
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $58.88 / $66.07	Professional	26	$56.23	$58.88	$66.07
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $194.98 / $208.93	Professional	TC	$181.97	$194.98	$208.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $251.19	Professional		$251.19	$251.19	$251.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	26	$61.66	$61.66	$61.66
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $190.55 / $190.55	Professional	TC	$190.55	$190.55	$190.55
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $173.78 / $239.88	Professional		$114.82	$173.78	$239.88
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $53.70	Professional	26	$34.67	$45.71	$53.70
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $134.90 / $186.21	Professional	TC	$81.28	$134.90	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $173.78 / $257.04	Professional		$112.20	$173.78	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $45.71 / $61.66	Professional	26	$30.20	$45.71	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $131.83 / $194.98	Professional	TC	$81.28	$131.83	$194.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $251.19 / $251.19	Professional		$213.80	$251.19	$251.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $56.23 / $56.23	Professional	26	$47.86	$56.23	$56.23
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $194.98 / $194.98	Professional	TC	$165.96	$194.98	$194.98