Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $70.79 / $70.79	Facility	26	$51.29	$70.79	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $173.78 / $331.13	Professional		$125.89	$173.78	$331.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $102.33 / $190.55	Professional	26	$60.26	$102.33	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $95.50 / $218.78	Professional	TC	$64.57	$95.50	$218.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $295.12 / $371.54	Professional		$239.88	$295.12	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $158.49 / $199.53	Professional	26	$128.82	$158.49	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $138.04 / $173.78	Professional	TC	$112.20	$138.04	$173.78
Medica Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $208.93 / $354.81	Professional		$131.83	$208.93	$354.81
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $109.65 / $204.17	Professional	26	$64.57	$109.65	$204.17
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $114.82 / $218.78	Professional	TC	$67.61	$114.82	$218.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $275.42 / $338.84	Professional		$269.15	$275.42	$338.84
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $147.91 / $169.82	Professional	26	$138.04	$147.91	$169.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $134.90 / $169.82	Professional	TC	$123.03	$134.90	$169.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Professional		$309.03	$309.03	$309.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	26	$151.36	$151.36	$151.36
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $158.49	Professional	TC	$158.49	$158.49	$158.49
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $208.93 / $245.47	Professional		$173.78	$208.93	$245.47
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $107.15 / $131.83	Professional	26	$74.13	$107.15	$131.83
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $109.65 / $117.49	Professional	TC	$83.18	$109.65	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $239.88 / $288.40	Professional		$147.91	$239.88	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $109.65 / $141.25	Professional	26	$63.10	$109.65	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $125.89 / $169.82	Professional	TC	$75.86	$125.89	$169.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $251.19 / $251.19	Professional		$213.80	$251.19	$251.19
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $138.04 / $138.04	Professional	26	$117.49	$138.04	$138.04
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $114.82 / $114.82	Professional	TC	$97.72	$114.82	$114.82