Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $44.67 / $69.18	Facility	26	$44.67	$44.67	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $93.33 / $251.19	Professional		$66.07	$93.33	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $75.86 / $131.83	Professional	26	$39.81	$75.86	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $66.07 / $102.33	Professional	TC	$28.18	$66.07	$102.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $213.80	Professional		$134.90	$169.82	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $87.10 / $107.15	Professional	26	$74.13	$87.10	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $104.71	Professional	TC	$66.07	$83.18	$104.71
Medica Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $123.03 / $616.60	Professional		$67.61	$123.03	$616.60
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $75.86 / $263.03	Professional	26	$42.66	$75.86	$263.03
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $40.74 / $263.03	Professional	TC	$24.55	$40.74	$263.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $144.54 / $194.98	Professional		$128.82	$144.54	$194.98
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $95.50 / $100.00	Professional	26	$85.11	$95.50	$100.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $48.98 / $93.33	Professional	TC	$45.71	$48.98	$93.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $128.82 / $128.82	Professional		$67.61	$128.82	$128.82
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $87.10 / $87.10	Professional	26	$44.67	$87.10	$87.10
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $39.81 / $39.81	Professional	TC	$22.39	$39.81	$39.81
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $109.65 / $154.88	Professional		$81.28	$109.65	$154.88
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $77.62	Professional	26	$45.71	$66.07	$77.62
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $54.95 / $74.13	Professional	TC	$32.36	$54.95	$74.13
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $125.89 / $177.83	Professional		$69.18	$125.89	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $77.62 / $112.20	Professional	26	$42.66	$77.62	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $42.66 / $77.62	Professional	TC	$24.55	$42.66	$77.62
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $162.18 / $190.55	Professional		$158.49	$162.18	$190.55
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $83.18 / $97.72	Professional	26	$81.28	$83.18	$97.72
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $79.43 / $93.33	Professional	TC	$75.86	$79.43	$93.33