Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $47.86 / $47.86	Facility	26	$47.86	$47.86	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $239.88 / $338.84	Professional		$128.82	$239.88	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $102.33 / $165.96	Professional	26	$45.71	$102.33	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $162.18 / $371.54	Professional	TC	$87.10	$162.18	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $323.59 / $398.11	Professional		$257.04	$323.59	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $109.65 / $138.04	Professional	26	$89.13	$109.65	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $208.93 / $263.03	Professional	TC	$169.82	$208.93	$263.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $245.47 / $870.96	Professional		$128.82	$245.47	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $95.50 / $295.12	Professional	26	$54.95	$95.50	$295.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $169.82 / $575.44	Professional	TC	$93.33	$169.82	$575.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $316.23	Professional		$263.03	$316.23	$316.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $114.82 / $114.82	Professional	26	$95.50	$114.82	$114.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $199.53	Professional	TC	$169.82	$199.53	$199.53
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $263.03	Professional		$158.49	$218.78	$263.03
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $91.20	Professional	26	$57.54	$77.62	$91.20
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $147.91 / $169.82	Professional	TC	$104.71	$147.91	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $316.23	Professional		$144.54	$213.80	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $77.62 / $107.15	Professional	26	$50.12	$77.62	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $141.25 / $204.17	Professional	TC	$95.50	$141.25	$204.17
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $281.84 / $281.84	Professional		$239.88	$281.84	$281.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $97.72 / $97.72	Professional	26	$83.18	$97.72	$97.72
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $181.97 / $181.97	Professional	TC	$154.88	$181.97	$181.97