Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $66.07 / $102.33	Facility	26	$66.07	$66.07	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $117.49 / $295.12	Professional		$93.33	$117.49	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $97.72 / $177.83	Professional	26	$57.54	$97.72	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $57.54 / $109.65	Professional	TC	$36.31	$57.54	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $223.87 / $281.84	Professional		$186.21	$223.87	$281.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $125.89 / $158.49	Professional	26	$107.15	$125.89	$158.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $97.72 / $123.03	Professional	TC	$77.62	$97.72	$123.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $169.82 / $870.96	Professional		$95.50	$169.82	$870.96
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $112.20 / $380.19	Professional	26	$63.10	$112.20	$380.19
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $53.70 / $309.03	Professional	TC	$30.90	$53.70	$309.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $199.53 / $257.04	Professional		$177.83	$199.53	$257.04
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $141.25 / $147.91	Professional	26	$125.89	$141.25	$147.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $61.66 / $109.65	Professional	TC	$52.48	$61.66	$109.65
Midlands Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $177.83 / $177.83	Professional		$95.50	$177.83	$177.83
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $128.82 / $128.82	Professional	26	$66.07	$128.82	$128.82
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $47.86 / $47.86	Professional	TC	$30.20	$47.86	$47.86
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $151.36 / $204.17	Professional		$112.20	$151.36	$204.17
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $97.72 / $114.82	Professional	26	$67.61	$97.72	$114.82
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $63.10 / $87.10	Professional	TC	$40.74	$63.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $173.78 / $257.04	Professional		$95.50	$173.78	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $114.82 / $165.96	Professional	26	$63.10	$114.82	$165.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $57.54 / $91.20	Professional	TC	$30.90	$57.54	$91.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $218.78 / $257.04	Professional		$208.93	$218.78	$257.04
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $123.03 / $144.54	Professional	26	$117.49	$123.03	$144.54
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $93.33 / $109.65	Professional	TC	$89.13	$93.33	$109.65