Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.63 / $17.63 / $17.63	Facility	26	$17.63	$17.63	$17.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.73 / $116.53 / $164.56	Professional		$88.73	$116.53	$164.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $17.67 / $52.20	Professional	26	$16.67	$17.67	$52.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.42 / $98.85 / $137.05	Professional	TC	$73.42	$98.85	$137.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $150.18 / $227.28 / $284.10	Professional		$150.18	$227.28	$284.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.14 / $39.56 / $49.45	Professional	26	$26.14	$39.56	$49.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.04 / $187.72 / $234.65	Professional	TC	$124.04	$187.72	$234.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $101.46 / $174.40 / $664.33	Professional		$101.46	$174.40	$664.33
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $22.13 / $34.11 / $113.72	Professional	26	$22.13	$34.11	$113.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $78.98 / $138.22 / $550.61	Professional	TC	$78.98	$138.22	$550.61
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $60.28 / $60.28 / $60.28	Facility	26	$60.28	$60.28	$60.28
Midlands Facility/Professional Professional Modifier Low / Median / High Price $97.59 / $200.18 / $261.19	Professional		$97.59	$200.18	$261.19
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $102.50 / $147.16 / $188.25	Professional		$102.50	$147.16	$188.25
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $22.74 / $30.64 / $34.93	Professional	26	$22.74	$30.64	$34.93
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $83.55 / $123.40 / $155.49	Professional	TC	$83.55	$123.40	$155.49
United Facility/Professional Professional Modifier Low / Median / High Price $116.27 / $169.10 / $179.25	Professional		$116.27	$169.10	$179.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.61 / $29.97 / $37.46	Professional	26	$20.61	$29.97	$37.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.55 / $114.06 / $145.13	Professional	TC	$86.55	$114.06	$145.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $165.10 / $194.20 / $194.20	Professional		$165.10	$194.20	$194.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $36.00 / $36.00	Professional	26	$30.60	$36.00	$36.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $134.50 / $158.19 / $158.19	Professional	TC	$134.50	$158.19	$158.19