Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.15 / $41.15 / $41.15	Facility	26	$41.15	$41.15	$41.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.89 / $199.53 / $284.47	Professional		$98.89	$199.53	$284.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.51 / $39.70 / $138.60	Professional	26	$36.51	$39.70	$138.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.20 / $160.87 / $193.36	Professional	TC	$63.20	$160.87	$193.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $207.44 / $253.65 / $317.07	Professional		$207.44	$253.65	$317.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.86 / $91.53 / $114.42	Professional	26	$74.86	$91.53	$114.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $132.58 / $162.12 / $202.65	Professional	TC	$132.58	$162.12	$202.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $139.10 / $214.45 / $1,267.82	Professional		$139.10	$214.45	$1,267.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $51.24 / $81.84 / $148.50	Professional	26	$51.24	$81.84	$148.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $88.06 / $135.77 / $1,108.00	Professional	TC	$88.06	$135.77	$1,108.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $135.47 / $135.47 / $135.47	Facility	26	$135.47	$135.47	$135.47
Midlands Facility/Professional Professional Modifier Low / Median / High Price $223.61 / $258.27 / $400.00	Professional		$223.61	$258.27	$400.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $139.44 / $188.57 / $233.77	Professional		$139.44	$188.57	$233.77
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $51.91 / $68.09 / $77.63	Professional	26	$51.91	$68.09	$77.63
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $87.53 / $118.36 / $152.22	Professional	TC	$87.53	$118.36	$152.22
United Facility/Professional Professional Modifier Low / Median / High Price $130.22 / $214.45 / $244.46	Professional		$130.22	$214.45	$244.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.53 / $78.68 / $109.74	Professional	26	$47.53	$78.68	$109.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.69 / $135.77 / $147.41	Professional	TC	$82.69	$135.77	$147.41
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $208.60 / $245.40 / $245.40	Professional		$208.60	$245.40	$245.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $77.00 / $90.60 / $90.60	Professional	26	$77.00	$90.60	$90.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $131.60 / $154.80 / $154.80	Professional	TC	$131.60	$154.80	$154.80