Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.04 / $39.04 / $39.04	Facility	26	$39.04	$39.04	$39.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.52 / $105.02 / $210.95	Professional		$36.52	$105.02	$210.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.00 / $57.09 / $126.38	Professional	26	$36.00	$57.09	$126.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.15 / $151.87 / $443.70	Professional	TC	$85.15	$151.87	$443.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $241.06 / $294.77 / $368.46	Professional		$241.06	$294.77	$368.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.05 / $86.88 / $108.60	Professional	26	$71.05	$86.88	$108.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $170.01 / $207.89 / $259.86	Professional	TC	$170.01	$207.89	$259.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $160.37 / $249.84 / $810.58	Professional		$160.37	$249.84	$810.58
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $46.50 / $75.33 / $242.65	Professional	26	$46.50	$75.33	$242.65
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $111.45 / $174.51 / $567.92	Professional	TC	$111.45	$174.51	$567.92
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $131.74 / $131.74 / $131.74	Facility	26	$131.74	$131.74	$131.74
Midlands Facility/Professional Professional Modifier Low / Median / High Price $255.60 / $297.83 / $342.88	Professional		$255.60	$297.83	$342.88
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $157.44 / $213.91 / $243.88	Professional		$157.44	$213.91	$243.88
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $64.68 / $73.75	Professional	26	$41.81	$64.68	$73.75
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $94.06 / $149.22 / $170.13	Professional	TC	$94.06	$149.22	$170.13
United Facility/Professional Professional Modifier Low / Median / High Price $150.19 / $213.82 / $267.27	Professional		$150.19	$213.82	$267.27
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.54 / $75.33 / $81.38	Professional	26	$45.54	$75.33	$81.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.65 / $137.16 / $189.78	Professional	TC	$104.65	$137.16	$189.78
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $232.30 / $273.30 / $273.30	Professional		$232.30	$273.30	$273.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.30 / $82.60 / $82.60	Professional	26	$70.30	$82.60	$82.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $162.10 / $190.70 / $190.70	Professional	TC	$162.10	$190.70	$190.70