Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.94 / $36.94 / $36.94	Facility	26	$36.94	$36.94	$36.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.40 / $133.90 / $469.92	Professional		$41.40	$133.90	$469.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $46.47 / $102.46	Professional	26	$33.56	$46.47	$102.46
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.39 / $49.95 / $126.45	Professional	52	$41.39	$49.95	$126.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.50 / $99.73 / $343.54	Professional	TC	$90.50	$99.73	$343.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $246.77 / $301.75 / $377.18	Professional		$246.77	$301.75	$377.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.23 / $82.22 / $102.78	Professional	26	$67.23	$82.22	$102.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $179.53 / $219.52 / $274.39	Professional	TC	$179.53	$219.52	$274.39
Medica Facility/Professional Professional Modifier Low / Median / High Price $164.51 / $255.19 / $491.40	Professional		$164.51	$255.19	$491.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $47.21 / $70.67 / $99.36	Professional	26	$47.21	$70.67	$99.36
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $117.85 / $184.52 / $598.35	Professional	TC	$117.85	$184.52	$598.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $124.58 / $124.58 / $124.58	Facility	26	$124.58	$124.58	$124.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $261.74 / $303.41 / $349.49	Professional		$261.74	$303.41	$349.49
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $161.21 / $218.45 / $249.06	Professional		$161.21	$218.45	$249.06
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $38.92 / $61.28 / $69.87	Professional	26	$38.92	$61.28	$69.87
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $99.47 / $157.16 / $179.19	Professional	TC	$99.47	$157.16	$179.19
United Facility/Professional Professional Modifier Low / Median / High Price $153.38 / $248.29 / $287.89	Professional		$153.38	$248.29	$287.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.74 / $68.76 / $77.30	Professional	26	$42.74	$68.76	$77.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.64 / $150.41 / $210.59	Professional	TC	$110.64	$150.41	$210.59
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $237.30 / $279.10 / $279.10	Professional		$237.30	$279.10	$279.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $66.59 / $78.30 / $78.30	Professional	26	$66.59	$78.30	$78.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $170.70 / $200.80 / $200.80	Professional	TC	$170.70	$200.80	$200.80