Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $77.62 / $77.62	Facility	26	$77.62	$77.62	$77.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $257.04 / $562.34	Professional		$204.17	$257.04	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $85.11 / $190.55	Professional	26	$72.44	$85.11	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $173.78 / $371.54	Professional	TC	$138.04	$173.78	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $537.03 / $660.69	Professional		$426.58	$537.03	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $173.78 / $218.78	Professional	26	$141.25	$173.78	$218.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $354.81 / $446.68	Professional	TC	$288.40	$354.81	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $707.95 / $1,412.54	Professional		$302.00	$707.95	$1,412.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $131.83 / $229.09	Professional	26	$81.28	$131.83	$229.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $602.56 / $1,000.00	Professional	TC	$208.93	$602.56	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $478.63 / $575.44	Professional		$436.52	$478.63	$575.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $158.49 / $186.21	Professional	26	$151.36	$158.49	$186.21
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $316.23 / $389.05	Professional	TC	$288.40	$316.23	$389.05
Midlands Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Professional		$512.86	$512.86	$512.86
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $165.96 / $165.96	Professional	26	$165.96	$165.96	$165.96
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $346.74 / $346.74	Professional	TC	$346.74	$346.74	$346.74
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $363.08 / $426.58	Professional		$263.03	$363.08	$426.58
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $128.82 / $144.54	Professional	26	$91.20	$128.82	$144.54
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $269.15 / $281.84	Professional	TC	$186.21	$269.15	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $602.56 / $1,174.90	Professional		$269.15	$602.56	$1,174.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $144.54 / $194.98	Professional	26	$81.28	$144.54	$194.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $416.87 / $1,000.00	Professional	TC	$181.97	$416.87	$1,000.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $588.84 / $588.84	Professional		$489.78	$588.84	$588.84
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $194.98 / $194.98	Professional	26	$165.96	$194.98	$194.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $389.05 / $389.05	Professional	TC	$331.13	$389.05	$389.05