Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $177.83 / $676.08 / $1,023.29	Facility		$177.83	$676.08	$1,023.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $30.20 / $30.20	Facility	26	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $74.13 / $239.88	Professional		$53.70	$74.13	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $52.48 / $138.04	Professional	26	$28.84	$52.48	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $43.65 / $323.59	Professional	TC	$25.12	$43.65	$323.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $141.25 / $173.78	Professional		$112.20	$141.25	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $89.13	Professional	26	$56.23	$70.79	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $69.18 / $87.10	Professional	TC	$53.70	$69.18	$87.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $74.13 / $102.33 / $457.09	Facility		$74.13	$102.33	$457.09
Medica Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $107.15 / $954.99	Professional		$56.23	$107.15	$954.99
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $63.10 / $371.54	Professional	26	$32.36	$63.10	$371.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $56.23 / $758.58	Professional	TC	$28.18	$56.23	$758.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $128.82 / $128.82	Professional		$114.82	$128.82	$128.82
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $74.13 / $74.13	Professional	26	$60.26	$74.13	$74.13
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $61.66	Professional	TC	$53.70	$53.70	$61.66
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $100.00 / $257.04	Professional		$69.18	$100.00	$257.04
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $51.29 / $61.66	Professional	26	$37.15	$51.29	$61.66
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.98 / $213.80	Professional	TC	$32.36	$48.98	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $97.72 / $169.82	Professional		$61.66	$97.72	$169.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $69.18	Professional	26	$31.62	$48.98	$69.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $44.67 / $89.13	Professional	TC	$30.20	$44.67	$89.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $123.03 / $123.03	Professional		$104.71	$123.03	$123.03
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $63.10 / $63.10	Professional	26	$53.70	$63.10	$63.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $60.26 / $60.26	Professional	TC	$51.29	$60.26	$60.26