Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.50 / $40.50 / $40.50	Facility	26	$40.50	$40.50	$40.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.89 / $62.59 / $231.60	Professional		$56.89	$62.59	$231.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.88 / $38.71 / $63.25	Professional	26	$34.88	$38.71	$63.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.17 / $19.98 / $168.34	Professional	TC	$18.17	$19.98	$168.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.89 / $322.69 / $403.36	Professional		$263.89	$322.69	$403.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.48 / $92.31 / $115.39	Professional	26	$75.48	$92.31	$115.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $188.41 / $230.38 / $287.98	Professional	TC	$188.41	$230.38	$287.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $107.22 / $194.94 / $246.04	Professional		$107.22	$194.94	$246.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $42.72 / $72.18 / $109.06	Professional	26	$42.72	$72.18	$109.06
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.95 / $117.28 / $166.77	Professional	TC	$69.95	$117.28	$166.77
Midlands Facility/Professional Professional Modifier Low / Median / High Price $107.18 / $246.04 / $354.26	Professional		$107.18	$246.04	$354.26
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $85.87 / $188.41 / $265.88	Professional		$85.87	$188.41	$265.88
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $51.21 / $68.09 / $77.63	Professional	26	$51.21	$68.09	$77.63
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $15.09 / $134.78 / $188.25	Professional	TC	$15.09	$134.78	$188.25
United Facility/Professional Professional Modifier Low / Median / High Price $107.22 / $164.17 / $225.98	Professional		$107.22	$164.17	$225.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $50.69 / $110.65	Professional	26	$34.65	$50.69	$110.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $70.36 / $117.43 / $276.77	Professional	TC	$70.36	$117.43	$276.77
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $253.30 / $298.00 / $298.00	Professional		$253.30	$298.00	$298.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $74.00 / $87.00 / $87.00	Professional	26	$74.00	$87.00	$87.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $179.30 / $211.00 / $211.00	Professional	TC	$179.30	$211.00	$211.00