Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.27 / $50.27 / $50.27	Facility	26	$50.27	$50.27	$50.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $121.81 / $138.22 / $252.95	Professional		$121.81	$138.22	$252.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $53.57 / $133.50	Professional	26	$31.76	$53.57	$133.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.04 / $99.05 / $177.61	Professional	TC	$90.04	$99.05	$177.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $289.91 / $354.49 / $443.12	Professional		$289.91	$354.49	$443.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.58 / $110.93 / $138.66	Professional	26	$77.58	$110.93	$138.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $199.19 / $243.57 / $304.45	Professional	TC	$199.19	$243.57	$304.45
Medica Facility/Professional Professional Modifier Low / Median / High Price $173.30 / $287.23 / $1,019.78	Professional		$173.30	$287.23	$1,019.78
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.59 / $72.79 / $310.80	Professional	26	$41.59	$72.79	$310.80
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $122.11 / $191.20 / $708.98	Professional	TC	$122.11	$191.20	$708.98
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $110.70 / $110.70 / $110.70	Facility	26	$110.70	$110.70	$110.70
Midlands Facility/Professional Professional Modifier Low / Median / High Price $181.00 / $321.66 / $402.55	Professional		$181.00	$321.66	$402.55
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $180.20 / $247.76 / $296.02	Professional		$180.20	$247.76	$296.02
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $42.64 / $69.93 / $93.80	Professional	26	$42.64	$69.93	$93.80
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $133.99 / $174.19 / $203.48	Professional	TC	$133.99	$174.19	$203.48
United Facility/Professional Professional Modifier Low / Median / High Price $165.79 / $241.15 / $333.76	Professional		$165.79	$241.15	$333.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.99 / $69.31 / $133.13	Professional	26	$51.99	$69.31	$133.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.02 / $186.03 / $243.72	Professional	TC	$124.02	$186.03	$243.72
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $258.10 / $303.60 / $303.60	Professional		$258.10	$303.60	$303.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $82.80 / $97.40 / $97.40	Professional	26	$82.80	$97.40	$97.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $175.30 / $206.20 / $206.20	Professional	TC	$175.30	$206.20	$206.20