Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $28.18 / $28.18	Facility	26	$19.95	$28.18	$28.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $123.03 / $331.13	Professional		$81.28	$123.03	$331.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.90 / $81.28	Professional	26	$25.12	$38.90	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $89.13 / $181.97	Professional	TC	$52.48	$89.13	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $245.47 / $309.03	Professional		$194.98	$245.47	$309.03
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 $144.54 / $181.97 / $223.87	Professional	TC	$144.54	$181.97	$223.87
Medica Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $162.18 / $251.19	Professional		$97.72	$162.18	$251.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $45.71 / $81.28	Professional	26	$28.84	$45.71	$81.28
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $117.49 / $208.93	Professional	TC	$69.18	$117.49	$208.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $218.78	Professional		$199.53	$199.53	$218.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $58.88 / $67.61	Professional	26	$54.95	$58.88	$67.61
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $144.54 / $158.49	Professional	TC	$134.90	$144.54	$158.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $60.26	Professional	26	$60.26	$60.26	$60.26
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $154.88	Professional	TC	$154.88	$154.88	$154.88
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $199.53	Professional		$123.03	$169.82	$199.53
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $46.77 / $52.48	Professional	26	$33.88	$46.77	$52.48
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $123.03 / $144.54	Professional	TC	$89.13	$123.03	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $177.83 / $223.87	Professional		$109.65	$177.83	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $48.98 / $61.66	Professional	26	$30.90	$48.98	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $134.90 / $169.82	Professional	TC	$79.43	$134.90	$169.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $229.09 / $229.09	Professional		$194.98	$229.09	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $61.66 / $61.66	Professional	26	$52.48	$61.66	$61.66
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $169.82 / $169.82	Professional	TC	$144.54	$169.82	$169.82