Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $40.74 / $40.74	Facility	26	$40.74	$40.74	$40.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $199.53 / $323.59	Professional		$104.71	$199.53	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $85.11 / $173.78	Professional	26	$38.90	$85.11	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $125.89 / $323.59	Professional	TC	$64.57	$125.89	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $263.03 / $323.59	Professional		$208.93	$263.03	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $120.23	Professional	26	$75.86	$95.50	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $165.96 / $208.93	Professional	TC	$131.83	$165.96	$208.93
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $204.17 / $707.95	Professional		$109.65	$204.17	$707.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $83.18 / $257.04	Professional	26	$43.65	$83.18	$257.04
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $141.25 / $446.68	Professional	TC	$74.13	$141.25	$446.68
Midlands Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $257.04 / $257.04	Professional		$218.78	$257.04	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $100.00	Professional	26	$81.28	$100.00	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $154.88 / $154.88	Professional	TC	$134.90	$154.88	$154.88
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $208.93	Professional		$128.82	$177.83	$208.93
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $67.61 / $77.62	Professional	26	$47.86	$67.61	$77.62
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $117.49 / $131.83	Professional	TC	$83.18	$117.49	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $173.78 / $257.04	Professional		$114.82	$173.78	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $66.07 / $100.00	Professional	26	$42.66	$66.07	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $104.71 / $158.49	Professional	TC	$72.44	$104.71	$158.49
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $229.09 / $229.09	Professional		$190.55	$229.09	$229.09
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $83.18 / $83.18	Professional	26	$70.79	$83.18	$83.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $144.54 / $144.54	Professional	TC	$120.23	$144.54	$144.54