Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.28 / $52.28 / $106.48	Facility		$52.28	$52.28	$106.48
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.17 / $33.17 / $33.17	Facility	26	$33.17	$33.17	$33.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.84 / $84.81 / $213.60	Professional		$45.84	$84.81	$213.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.33 / $30.26 / $50.34	Professional	26	$28.33	$30.26	$50.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $23.96 / $23.96 / $70.69	Professional	52	$23.96	$23.96	$70.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.62 / $56.46 / $79.62	Professional	TC	$17.62	$56.46	$79.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.66 / $99.83 / $123.00	Professional		$80.66	$99.83	$123.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.41 / $62.11 / $77.64	Professional	26	$50.41	$62.11	$77.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.29 / $37.86 / $45.36	Professional	TC	$36.29	$37.86	$45.36
Medica Facility/Professional Facility Modifier Low / Median / High Price $67.81 / $95.84 / $205.56	Facility		$67.81	$95.84	$205.56
Medica Facility/Professional Professional Modifier Low / Median / High Price $78.83 / $113.51 / $459.15	Professional		$78.83	$113.51	$459.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $34.89 / $48.66 / $188.73	Professional	26	$34.89	$48.66	$188.73
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $39.40 / $70.80 / $313.58	Professional	TC	$39.40	$70.80	$313.58
Midlands Facility/Professional Facility Modifier Low / Median / High Price $105.21 / $115.63 / $141.96	Facility		$105.21	$115.63	$141.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.13 / $132.22 / $144.80	Professional		$93.13	$132.22	$144.80
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $66.58 / $88.75 / $147.37	Professional		$66.58	$88.75	$147.37
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.16 / $50.50 / $57.57	Professional	26	$30.16	$50.50	$57.57
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $25.08 / $33.64 / $96.31	Professional	TC	$25.08	$33.64	$96.31
United Facility/Professional Professional Modifier Low / Median / High Price $58.68 / $81.18 / $181.44	Professional		$58.68	$81.18	$181.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.71 / $39.42 / $63.44	Professional	26	$31.71	$39.42	$63.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $39.40 / $118.00	Professional	TC	$21.64	$39.40	$118.00
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $86.90 / $102.20 / $106.30	Professional		$86.90	$102.20	$106.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $54.80 / $64.50 / $67.09	Professional	26	$54.80	$64.50	$67.09
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $32.00 / $37.70 / $39.20	Professional	TC	$32.00	$37.70	$39.20