Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.58 / $20.58 / $20.58	Facility	26	$20.58	$20.58	$20.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.54 / $88.91 / $166.90	Professional		$78.54	$88.91	$166.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.50 / $20.81 / $71.09	Professional	26	$17.50	$20.81	$71.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.64 / $71.42 / $135.65	Professional	TC	$59.64	$71.42	$135.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.59 / $231.16 / $288.95	Professional		$182.59	$231.16	$288.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $45.77 / $57.21	Professional	26	$37.43	$45.77	$57.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $136.50 / $185.39 / $231.74	Professional	TC	$136.50	$185.39	$231.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $96.98 / $168.97 / $637.19	Professional		$96.98	$168.97	$637.19
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $24.46 / $38.54 / $127.82	Professional	26	$24.46	$38.54	$127.82
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $72.52 / $120.88 / $509.36	Professional	TC	$72.52	$120.88	$509.36
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $81.50 / $81.50 / $81.50	Facility	26	$81.50	$81.50	$81.50
Midlands Facility/Professional Professional Modifier Low / Median / High Price $154.05 / $198.07 / $249.18	Professional		$154.05	$198.07	$249.18
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $108.98 / $162.22 / $190.84	Professional		$108.98	$162.22	$190.84
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.62 / $33.31 / $38.81	Professional	26	$21.62	$33.31	$38.81
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $80.65 / $129.22 / $152.02	Professional	TC	$80.65	$129.22	$152.02
United Facility/Professional Professional Modifier Low / Median / High Price $96.98 / $138.58 / $173.66	Professional		$96.98	$138.58	$173.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.57 / $32.61 / $40.76	Professional	26	$23.57	$32.61	$40.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.41 / $120.88 / $151.10	Professional	TC	$84.41	$120.88	$151.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $168.40 / $198.20 / $198.20	Professional		$168.40	$198.20	$198.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $34.29 / $40.29 / $40.29	Professional	26	$34.29	$40.29	$40.29
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.19 / $157.80 / $157.80	Professional	TC	$134.19	$157.80	$157.80