Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $47.86 / $47.86	Facility	26	$45.71	$47.86	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $89.13 / $186.21	Professional		$81.28	$89.13	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $46.77 / $100.00	Professional	26	$39.81	$46.77	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $43.65 / $93.33	Professional	TC	$39.81	$43.65	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $186.21 / $234.42	Professional		$162.18	$186.21	$234.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $93.33 / $114.82	Professional	26	$85.11	$93.33	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $93.33 / $117.49	Professional	TC	$77.62	$93.33	$117.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $134.90 / $562.34	Professional		$83.18	$134.90	$562.34
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $316.23	Professional	26	$44.67	$77.62	$316.23
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $67.61 / $316.23	Professional	TC	$34.67	$67.61	$316.23
Midlands Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $169.82 / $213.80	Professional		$162.18	$169.82	$213.80
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $93.33 / $109.65	Professional	26	$89.13	$93.33	$109.65
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $77.62 / $104.71	Professional	TC	$70.79	$77.62	$104.71
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $190.55	Professional		$169.82	$169.82	$190.55
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $102.33	Professional	26	$93.33	$93.33	$102.33
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $77.62 / $89.13	Professional	TC	$77.62	$77.62	$89.13
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $141.25 / $177.83	Professional		$97.72	$141.25	$177.83
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $89.13	Professional	26	$51.29	$70.79	$89.13
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $69.18 / $83.18	Professional	TC	$42.66	$69.18	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $147.91 / $194.98	Professional		$85.11	$147.91	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $79.43 / $114.82	Professional	26	$45.71	$79.43	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $67.61 / $100.00	Professional	TC	$38.90	$67.61	$100.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $213.80 / $213.80	Professional		$173.78	$213.80	$213.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $107.15 / $107.15	Professional	26	$87.10	$107.15	$107.15
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $104.71 / $104.71	Professional	TC	$87.10	$104.71	$104.71