Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $79.43 / $91.20	Professional		$63.10	$79.43	$91.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $21.38 / $83.18	Professional	26	$19.95	$21.38	$83.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $51.29 / $131.83	Professional	TC	$28.18	$51.29	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $109.65 / $181.97	Professional		$87.10	$109.65	$181.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $38.02 / $56.23	Professional	26	$26.92	$38.02	$56.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $75.86 / $128.82	Professional	TC	$61.66	$75.86	$128.82
Medica Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $91.20 / $213.80	Facility		$77.62	$91.20	$213.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $58.88 / $407.38	Professional		$38.02	$58.88	$407.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $46.77 / $245.47	Professional	26	$13.80	$46.77	$245.47
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $35.48 / $269.15	Professional	TC	$23.44	$35.48	$269.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $123.03	Professional		$104.71	$104.71	$123.03
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $41.69 / $41.69	Professional	26	$38.02	$41.69	$41.69
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $85.11	Professional	TC	$63.10	$63.10	$85.11
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $120.23 / $138.04	Professional		$91.20	$120.23	$138.04
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $39.81 / $43.65	Professional	26	$31.62	$39.81	$43.65
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $83.18 / $100.00	Professional	TC	$61.66	$83.18	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $50.12 / $125.89	Professional		$38.02	$50.12	$125.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $18.62 / $46.77	Professional	26	$12.88	$18.62	$46.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $89.13	Professional	TC	$23.44	$31.62	$89.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $154.88 / $165.96	Professional		$120.23	$154.88	$165.96
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $47.86 / $51.29	Professional	26	$37.15	$47.86	$51.29
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $104.71 / $114.82	Professional	TC	$83.18	$104.71	$114.82