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 $213.80 / $338.84 / $1,174.90	Professional		$213.80	$338.84	$1,174.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $100.00 / $223.87	Professional	26	$57.54	$100.00	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $229.09 / $436.52	Professional	TC	$162.18	$229.09	$436.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $562.34 / $707.95	Professional		$446.68	$562.34	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $141.25 / $173.78	Professional	26	$112.20	$141.25	$173.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $426.58 / $524.81	Professional	TC	$338.84	$426.58	$524.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $380.19 / $660.69	Professional		$223.87	$380.19	$660.69
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $112.20 / $177.83	Professional	26	$64.57	$112.20	$177.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $302.00 / $2,089.30	Professional	TC	$169.82	$302.00	$2,089.30
Midlands Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $501.19 / $537.03	Professional		$467.74	$501.19	$537.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $128.82 / $147.91	Professional	26	$120.23	$128.82	$147.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $371.54 / $380.19	Professional	TC	$346.74	$371.54	$380.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $501.19 / $501.19	Professional		$501.19	$501.19	$501.19
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 $371.54 / $371.54 / $371.54	Professional	TC	$371.54	$371.54	$371.54
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $389.05 / $478.63	Professional		$288.40	$389.05	$478.63
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 $213.80 / $295.12 / $398.11	Professional	TC	$213.80	$295.12	$398.11
United Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $416.87 / $575.44	Professional		$257.04	$416.87	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $138.04	Professional	26	$64.57	$109.65	$138.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $323.59 / $416.87	Professional	TC	$190.55	$323.59	$416.87
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $524.81 / $524.81	Professional		$446.68	$524.81	$524.81
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 $338.84 / $398.11 / $398.11	Professional	TC	$338.84	$398.11	$398.11