Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.79 / $33.79 / $33.79	Facility	26	$33.79	$33.79	$33.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $121.26 / $150.52 / $260.92	Professional		$121.26	$150.52	$260.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.55 / $52.80 / $117.90	Professional	26	$31.55	$52.80	$117.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $53.76 / $53.76 / $103.70	Professional	52	$53.76	$53.76	$103.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.17 / $147.24 / $292.50	Professional	TC	$82.17	$147.24	$292.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.18 / $276.92 / $346.16	Professional		$181.18	$276.92	$346.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.23 / $75.23 / $94.05	Professional	26	$49.23	$75.23	$94.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.94 / $201.68 / $252.10	Professional	TC	$131.94	$201.68	$252.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $125.23 / $229.99 / $778.42	Professional		$125.23	$229.99	$778.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.59 / $66.69 / $290.60	Professional	26	$41.59	$66.69	$290.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $98.06 / $165.83 / $570.15	Professional	TC	$98.06	$165.83	$570.15
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $107.82 / $107.82 / $107.82	Facility	26	$107.82	$107.82	$107.82
Midlands Facility/Professional Professional Modifier Low / Median / High Price $169.00 / $252.37 / $306.25	Professional		$169.00	$252.37	$306.25
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $136.35 / $197.91 / $228.36	Professional		$136.35	$197.91	$228.36
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.04 / $55.61 / $63.40	Professional	26	$41.04	$55.61	$63.40
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $100.55 / $141.88 / $164.96	Professional	TC	$100.55	$141.88	$164.96
United Facility/Professional Professional Modifier Low / Median / High Price $131.09 / $149.18 / $247.62	Professional		$131.09	$149.18	$247.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.13 / $53.97 / $70.50	Professional	26	$38.13	$53.97	$70.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.06 / $107.56 / $178.30	Professional	TC	$98.06	$107.56	$178.30
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $209.30 / $246.20 / $246.20	Professional		$209.30	$246.20	$246.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $58.10 / $68.40 / $68.40	Professional	26	$58.10	$68.40	$68.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $151.19 / $177.90 / $177.90	Professional	TC	$151.19	$177.90	$177.90