Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.41 / $6.41 / $6.41	Facility	26	$6.41	$6.41	$6.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.82 / $23.99 / $64.97	Professional	26	$5.82	$23.99	$64.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.53 / $79.12 / $207.37	Professional	TC	$20.53	$79.12	$207.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.19 / $50.98 / $62.81	Professional	26	$41.19	$50.98	$62.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $133.29 / $164.33 / $203.26	Professional	TC	$133.29	$164.33	$203.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $149.40 / $149.40 / $149.40	Professional	26	$149.40	$149.40	$149.40
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $393.12 / $393.12 / $393.12	Professional	TC	$393.12	$393.12	$393.12
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $41.42 / $47.22	Professional	26	$30.60	$41.42	$47.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $97.24 / $129.93 / $148.13	Professional	TC	$97.24	$129.93	$148.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.44 / $36.45 / $48.60	Professional	26	$19.44	$36.45	$48.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.40 / $154.46 / $216.99	Professional	TC	$100.40	$154.46	$216.99
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $48.70 / $50.70 / $59.60	Professional	26	$48.70	$50.70	$59.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $152.80 / $158.90 / $187.00	Professional	TC	$152.80	$158.90	$187.00