Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $123.03 / $630.96 / $954.99	Facility		$123.03	$630.96	$954.99
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $12.88 / $12.88	Facility	26	$12.88	$12.88	$12.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $39.81 / $95.50	Professional		$32.36	$39.81	$95.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $21.38 / $63.10	Professional	26	$12.59	$21.38	$63.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $25.70 / $45.71	Professional	TC	$20.89	$25.70	$45.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $91.20 / $114.82	Professional		$58.88	$91.20	$114.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $30.90 / $38.90	Professional	26	$19.95	$30.90	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $60.26 / $75.86	Professional	TC	$38.90	$60.26	$75.86
Medica Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $57.54 / $87.10	Facility		$45.71	$57.54	$87.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $54.95 / $288.40	Professional		$34.67	$54.95	$288.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $22.91 / $204.17	Professional	26	$14.79	$22.91	$204.17
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $32.36 / $229.09	Professional	TC	$19.05	$32.36	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $75.86 / $81.28	Professional		$74.13	$75.86	$81.28
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $33.11 / $33.11	Professional	26	$27.54	$33.11	$33.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $42.66 / $53.70	Professional	TC	$42.66	$42.66	$53.70
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $74.13	Professional		$39.81	$53.70	$74.13
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.91 / $25.70	Professional	26	$16.98	$22.91	$25.70
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $34.67 / $48.98	Professional	TC	$23.99	$34.67	$48.98
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $46.77 / $85.11	Professional		$37.15	$46.77	$85.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.38 / $30.90	Professional	26	$14.79	$21.38	$30.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $29.51 / $50.12	Professional	TC	$20.89	$29.51	$50.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $79.43	Professional		$67.61	$79.43	$79.43
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $28.18 / $28.18	Professional	26	$23.44	$28.18	$28.18
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $52.48 / $52.48	Professional	TC	$44.67	$52.48	$52.48