Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $23.99 / $23.99	Facility	26	$23.99	$23.99	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $169.82 / $281.84	Professional		$114.82	$169.82	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $26.92 / $54.95	Professional	26	$20.89	$26.92	$54.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $117.49 / $239.88	Professional	TC	$93.33	$117.49	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $269.15 / $331.13	Professional		$239.88	$269.15	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $47.86 / $58.88	Professional	26	$43.65	$47.86	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $218.78 / $275.42	Professional	TC	$194.98	$218.78	$275.42
Medica Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $234.42 / $1,047.13	Professional		$117.49	$234.42	$1,047.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $43.65 / $302.00	Professional	26	$24.55	$43.65	$302.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $190.55 / $912.01	Professional	TC	$114.82	$190.55	$912.01
Midlands Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $288.40	Professional		$239.88	$239.88	$288.40
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $47.86 / $47.86	Professional	26	$47.86	$47.86	$47.86
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $194.98 / $239.88	Professional	TC	$194.98	$194.98	$239.88
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $239.88	Professional		$147.91	$213.80	$239.88
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.02 / $44.67	Professional	26	$25.12	$38.02	$44.67
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $173.78 / $194.98	Professional	TC	$120.23	$173.78	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $229.09 / $346.74	Professional		$138.04	$229.09	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $41.69 / $52.48	Professional	26	$25.12	$41.69	$52.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $186.21 / $281.84	Professional	TC	$112.20	$186.21	$281.84
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $269.15 / $275.42	Professional		$229.09	$269.15	$275.42
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $50.12 / $52.48	Professional	26	$42.66	$50.12	$52.48
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $218.78 / $223.87	Professional	TC	$186.21	$218.78	$223.87