Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $52.48 / $52.48	Facility	26	$52.48	$52.48	$52.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $234.42 / $724.44	Professional		$186.21	$234.42	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $53.70 / $177.83	Professional	26	$44.67	$53.70	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $169.82 / $229.09	Professional	TC	$141.25	$169.82	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $489.78 / $602.56	Professional		$389.05	$489.78	$602.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $120.23 / $151.36	Professional	26	$97.72	$120.23	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $363.08 / $457.09	Professional	TC	$295.12	$363.08	$457.09
Medica Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $380.19 / $588.84	Professional		$204.17	$380.19	$588.84
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $93.33 / $154.88	Professional	26	$54.95	$93.33	$154.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $288.40 / $512.86	Professional	TC	$181.97	$288.40	$512.86
Midlands Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $436.52 / $524.81	Professional		$407.38	$436.52	$524.81
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $109.65 / $128.82	Professional	26	$104.71	$109.65	$128.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $323.59 / $398.11	Professional	TC	$302.00	$323.59	$398.11
Midlands Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $478.63 / $478.63	Professional		$478.63	$478.63	$478.63
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Professional	26	$114.82	$114.82	$114.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $363.08 / $363.08 / $363.08	Professional	TC	$363.08	$363.08	$363.08
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $338.84 / $389.05	Professional		$245.47	$338.84	$389.05
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $87.10 / $100.00	Professional	26	$63.10	$87.10	$100.00
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $275.42 / $295.12	Professional	TC	$194.98	$275.42	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $416.87 / $537.03	Professional		$245.47	$416.87	$537.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $100.00 / $134.90	Professional	26	$60.26	$100.00	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $316.23 / $407.38	Professional	TC	$186.21	$316.23	$407.38
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $537.03 / $537.03	Professional		$457.09	$537.03	$537.03
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