Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.00 / $89.00 / $89.00	Professional		$89.00	$89.00	$89.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.27 / $33.27 / $33.27	Professional	26	$33.27	$33.27	$33.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.73 / $55.73 / $55.73	Professional	TC	$55.73	$55.73	$55.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.40 / $207.68 / $309.32	Professional		$153.40	$207.68	$309.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.48 / $73.75 / $109.84	Professional	26	$54.48	$73.75	$109.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $98.93 / $133.93 / $199.48	Professional	TC	$98.93	$133.93	$199.48
Medica Facility/Professional Professional Modifier Low / Median / High Price $77.23 / $280.75 / $881.27	Professional		$77.23	$280.75	$881.27
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $27.80 / $119.47 / $342.38	Professional	26	$27.80	$119.47	$342.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $49.44 / $161.86 / $549.40	Professional	TC	$49.44	$161.86	$549.40
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $149.87 / $149.87 / $149.87	Facility	26	$149.87	$149.87	$149.87
Midlands Facility/Professional Professional Modifier Low / Median / High Price $178.00 / $225.94 / $267.73	Professional		$178.00	$225.94	$267.73
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $167.36 / $213.27 / $275.01	Professional		$167.36	$213.27	$275.01
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $68.73 / $76.83 / $97.47	Professional	26	$68.73	$76.83	$97.47
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $114.98 / $136.44 / $177.54	Professional	TC	$114.98	$136.44	$177.54
United Facility/Professional Professional Modifier Low / Median / High Price $71.50 / $77.23 / $280.75	Professional		$71.50	$77.23	$280.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.16 / $27.80 / $108.65	Professional	26	$25.16	$27.80	$108.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.34 / $49.44 / $191.22	Professional	TC	$46.34	$49.44	$191.22
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $196.90 / $253.30 / $272.39	Professional		$196.90	$253.30	$272.39
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.90 / $91.30 / $98.10	Professional	26	$70.90	$91.30	$98.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $126.00 / $162.10 / $174.30	Professional	TC	$126.00	$162.10	$174.30