Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $47.86 / $47.86	Facility	26	$47.86	$47.86	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $239.88 / $512.86	Professional		$141.25	$239.88	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $131.83	Professional	26	$44.67	$70.79	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $165.96 / $489.78	Professional	TC	$104.71	$165.96	$489.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $380.19 / $478.63	Professional		$302.00	$380.19	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $109.65 / $138.04	Professional	26	$87.10	$109.65	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $269.15 / $338.84	Professional	TC	$218.78	$269.15	$338.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $251.19 / $416.87	Professional		$144.54	$251.19	$416.87
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $120.23	Professional	26	$54.95	$85.11	$120.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $204.17 / $302.00	Professional	TC	$134.90	$204.17	$302.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $338.84 / $380.19	Professional		$309.03	$338.84	$380.19
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $100.00 / $117.49	Professional	26	$95.50	$100.00	$117.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $239.88 / $263.03	Professional	TC	$213.80	$239.88	$263.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $346.74	Professional		$346.74	$346.74	$346.74
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Professional	26	$104.71	$104.71	$104.71
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $245.47 / $245.47	Professional	TC	$245.47	$245.47	$245.47
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $263.03 / $309.03	Professional		$186.21	$263.03	$309.03
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $91.20	Professional	26	$57.54	$79.43	$91.20
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $190.55 / $218.78	Professional	TC	$134.90	$190.55	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $269.15 / $371.54	Professional		$186.21	$269.15	$371.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $104.71	Professional	26	$52.48	$77.62	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $194.98 / $263.03	Professional	TC	$134.90	$194.98	$263.03
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $346.74 / $346.74	Professional		$295.12	$346.74	$346.74
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $102.33 / $102.33	Professional	26	$87.10	$102.33	$102.33
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $245.47 / $245.47	Professional	TC	$204.17	$245.47	$245.47