Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $114.82	Facility	26	$74.13	$74.13	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $223.87 / $380.19	Professional		$169.82	$223.87	$380.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $91.20 / $269.15	Professional	26	$63.10	$91.20	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $141.25 / $239.88	Professional	TC	$107.15	$141.25	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $398.11 / $501.19	Professional		$363.08	$398.11	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $144.54 / $177.83	Professional	26	$131.83	$144.54	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $251.19 / $316.23	Professional	TC	$218.78	$251.19	$316.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $389.05 / $1,659.59	Professional		$204.17	$389.05	$1,659.59
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $128.82 / $724.44	Professional	26	$79.43	$128.82	$724.44
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $263.03 / $977.24	Professional	TC	$144.54	$263.03	$977.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $436.52	Professional		$363.08	$363.08	$436.52
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $141.25 / $158.49	Professional	26	$141.25	$141.25	$158.49
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $218.78 / $281.84	Professional	TC	$218.78	$218.78	$281.84
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $309.03 / $407.38	Professional		$218.78	$309.03	$407.38
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $114.82 / $144.54	Professional	26	$85.11	$114.82	$144.54
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $204.17 / $281.84	Professional	TC	$141.25	$204.17	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $346.74 / $524.81	Professional		$204.17	$346.74	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $128.82 / $186.21	Professional	26	$74.13	$128.82	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $223.87 / $371.54	Professional	TC	$128.82	$223.87	$371.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $426.58 / $446.68	Professional		$363.08	$426.58	$446.68
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $158.49 / $165.96	Professional	26	$134.90	$158.49	$165.96
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $269.15 / $281.84	Professional	TC	$229.09	$269.15	$281.84