Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $62.96 / $62.96 / $62.96	Facility		$62.96	$62.96	$62.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.15 / $35.15 / $35.15	Facility	26	$35.15	$35.15	$35.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.96 / $230.00 / $253.00	Professional		$62.96	$230.00	$253.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.39 / $56.14 / $89.68	Professional	26	$17.39	$56.14	$89.68
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.80 / $148.65 / $163.52	Professional	TC	$27.80	$148.65	$163.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.85 / $148.03 / $185.04	Professional		$114.85	$148.03	$185.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.08 / $82.58 / $103.23	Professional	26	$64.08	$82.58	$103.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.78 / $65.44 / $81.81	Professional	TC	$50.78	$65.44	$81.81
Medica Facility/Professional Facility Modifier Low / Median / High Price $58.71 / $100.66 / $496.75	Facility		$58.71	$100.66	$496.75
Medica Facility/Professional Professional Modifier Low / Median / High Price $83.02 / $172.95 / $1,317.18	Professional		$83.02	$172.95	$1,317.18
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $44.96 / $93.65 / $638.00	Professional	26	$44.96	$93.65	$638.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $36.02 / $79.30 / $870.88	Professional	TC	$36.02	$79.30	$870.88
Midlands Facility/Professional Facility Modifier Low / Median / High Price $62.32 / $138.58 / $195.44	Facility		$62.32	$138.58	$195.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.58 / $156.12 / $373.46	Professional		$138.58	$156.12	$373.46
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $77.66 / $118.00 / $315.63	Professional		$77.66	$118.00	$315.63
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.90 / $66.98 / $128.22	Professional	26	$43.90	$66.98	$128.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.22 / $47.09 / $187.40	Professional	TC	$32.22	$47.09	$187.40
United Facility/Professional Facility Modifier Low / Median / High Price $821.00 / $821.00 / $821.00	Facility		$821.00	$821.00	$821.00
United Facility/Professional Professional Modifier Low / Median / High Price $83.51 / $128.47 / $195.19	Professional		$83.51	$128.47	$195.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.96 / $71.59 / $106.04	Professional	26	$44.96	$71.59	$106.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.02 / $55.92 / $90.19	Professional	TC	$36.02	$55.92	$90.19
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.20 / $150.80 / $150.80	Professional		$123.20	$150.80	$150.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.00 / $85.60 / $85.60	Professional	26	$70.00	$85.60	$85.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.30 / $65.20 / $65.20	Professional	TC	$53.30	$65.20	$65.20