Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.16 / $48.16 / $48.16	Facility	26	$48.16	$48.16	$48.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.44 / $247.93 / $353.78	Professional		$120.44	$247.93	$353.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.59 / $46.89 / $149.40	Professional	26	$42.59	$46.89	$149.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.52 / $201.03 / $550.02	Professional	TC	$78.52	$201.03	$550.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.85 / $307.95 / $384.94	Professional		$251.85	$307.95	$384.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.54 / $107.05 / $133.81	Professional	26	$87.54	$107.05	$133.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.30 / $200.91 / $251.13	Professional	TC	$164.30	$200.91	$251.13
Medica Facility/Professional Professional Modifier Low / Median / High Price $187.18 / $288.56 / $1,609.32	Professional		$187.18	$288.56	$1,609.32
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $60.03 / $92.70 / $379.76	Professional	26	$60.03	$92.70	$379.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $127.04 / $195.86 / $1,345.00	Professional	TC	$127.04	$195.86	$1,345.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $156.93 / $156.93 / $156.93	Facility	26	$156.93	$156.93	$156.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $280.39 / $359.75 / $509.00	Professional		$280.39	$359.75	$509.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $190.03 / $253.56 / $327.27	Professional		$190.03	$253.56	$327.27
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $60.92 / $79.44 / $90.57	Professional	26	$60.92	$79.44	$90.57
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $122.50 / $164.31 / $250.07	Professional	TC	$122.50	$164.31	$250.07
United Facility/Professional Professional Modifier Low / Median / High Price $158.58 / $288.56 / $361.58	Professional		$158.58	$288.56	$361.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.92 / $90.20 / $105.04	Professional	26	$55.92	$90.20	$105.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.66 / $190.56 / $261.54	Professional	TC	$102.66	$190.56	$261.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $252.80 / $297.50 / $297.50	Professional		$252.80	$297.50	$297.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $89.80 / $105.70 / $105.70	Professional	26	$89.80	$105.70	$105.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $163.00 / $191.80 / $191.80	Professional	TC	$163.00	$191.80	$191.80