Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.25 / $52.25 / $52.25	Facility	26	$52.25	$52.25	$52.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.93 / $247.93 / $353.78	Professional		$123.93	$247.93	$353.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.89 / $49.63 / $149.40	Professional	26	$46.89	$49.63	$149.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $61.97 / $61.97 / $72.23	Professional	52	$61.97	$61.97	$72.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.52 / $201.03 / $515.30	Professional	TC	$78.52	$201.03	$515.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $258.83 / $316.49 / $395.61	Professional		$258.83	$316.49	$395.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.16 / $116.36 / $145.44	Professional	26	$95.16	$116.36	$145.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.66 / $200.13 / $250.16	Professional	TC	$163.66	$200.13	$250.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $191.08 / $294.58 / $1,609.32	Professional		$191.08	$294.58	$1,609.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $61.31 / $107.29 / $394.61	Professional	26	$61.31	$107.29	$394.61
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $121.42 / $187.18 / $1,384.00	Professional	TC	$121.42	$187.18	$1,384.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $160.66 / $160.66 / $160.66	Facility	26	$160.66	$160.66	$160.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $288.20 / $354.20 / $509.00	Professional		$288.20	$354.20	$509.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $192.18 / $257.74 / $326.17	Professional		$192.18	$257.74	$326.17
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $62.81 / $84.13 / $98.33	Professional	26	$62.81	$84.13	$98.33
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $121.52 / $162.03 / $248.98	Professional	TC	$121.52	$162.03	$248.98
United Facility/Professional Professional Modifier Low / Median / High Price $163.38 / $294.58 / $363.02	Professional		$163.38	$294.58	$363.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.72 / $107.40 / $107.40	Professional	26	$60.72	$107.40	$107.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.66 / $187.18 / $260.83	Professional	TC	$102.66	$187.18	$260.83
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $259.89 / $305.80 / $305.80	Professional		$259.89	$305.80	$305.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $97.50 / $114.80 / $114.80	Professional	26	$97.50	$114.80	$114.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $162.40 / $191.00 / $191.00	Professional	TC	$162.40	$191.00	$191.00