Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.05 / $31.05 / $31.05	Facility	26	$31.05	$31.05	$31.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.42 / $77.64 / $113.71	Professional		$61.42	$77.64	$113.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.77 / $28.10 / $47.91	Professional	26	$26.77	$28.10	$47.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.71 / $30.71 / $68.77	Professional	52	$30.71	$30.71	$68.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.65 / $49.53 / $68.37	Professional	TC	$34.65	$49.53	$68.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.55 / $159.79 / $199.74	Professional		$104.55	$159.79	$199.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.68 / $69.81 / $87.27	Professional	26	$45.68	$69.81	$87.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.87 / $89.98 / $112.48	Professional	TC	$58.87	$89.98	$112.48
Medica Facility/Professional Professional Modifier Low / Median / High Price $78.78 / $124.67 / $497.00	Professional		$78.78	$124.67	$497.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $31.76 / $58.33 / $320.31	Professional	26	$31.76	$58.33	$320.31
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $43.03 / $66.34 / $320.31	Professional	TC	$43.03	$66.34	$320.31
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $98.95 / $98.95 / $98.95	Facility	26	$98.95	$98.95	$98.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $133.00 / $149.29 / $170.54	Professional		$133.00	$149.29	$170.54
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $82.07 / $115.75 / $140.40	Professional		$82.07	$115.75	$140.40
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $33.82 / $50.85 / $58.22	Professional	26	$33.82	$50.85	$58.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $45.22 / $64.68 / $87.03	Professional	TC	$45.22	$64.68	$87.03
United Facility/Professional Professional Modifier Low / Median / High Price $80.87 / $100.78 / $170.68	Professional		$80.87	$100.78	$170.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.59 / $41.47 / $63.44	Professional	26	$32.59	$41.47	$63.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.35 / $58.98 / $107.24	Professional	TC	$42.35	$58.98	$107.24
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $120.90 / $142.30 / $142.30	Professional		$120.90	$142.30	$142.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $53.40 / $62.80 / $62.80	Professional	26	$53.40	$62.80	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $67.59 / $79.50 / $79.50	Professional	TC	$67.59	$79.50	$79.50