Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.85 / $12.85 / $12.85	Facility	26	$12.85	$12.85	$12.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.63 / $56.38 / $192.24	Professional		$52.63	$56.38	$192.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.24 / $15.68 / $37.75	Professional	26	$11.24	$15.68	$37.75
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.12 / $28.49 / $30.29	Professional	52	$25.12	$28.49	$30.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.39 / $43.86 / $147.74	Professional	TC	$41.39	$43.86	$147.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.58 / $119.34 / $149.18	Professional		$86.58	$119.34	$149.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.88 / $23.73 / $29.66	Professional	26	$17.88	$23.73	$29.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.64 / $95.61 / $119.52	Professional	TC	$67.64	$95.61	$119.52
Medica Facility/Professional Professional Modifier Low / Median / High Price $54.39 / $90.17 / $346.85	Professional		$54.39	$90.17	$346.85
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.57 / $21.80 / $74.58	Professional	26	$13.57	$21.80	$74.58
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $40.70 / $69.19 / $272.27	Professional	TC	$40.70	$69.19	$272.27
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.34 / $104.13 / $135.55	Professional		$66.34	$104.13	$135.55
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $63.92 / $86.45 / $109.97	Professional		$63.92	$86.45	$109.97
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.89 / $19.25 / $22.64	Professional	26	$13.89	$19.25	$22.64
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $48.91 / $66.14 / $87.33	Professional	TC	$48.91	$66.14	$87.33
United Facility/Professional Professional Modifier Low / Median / High Price $52.63 / $96.46 / $159.46	Professional		$52.63	$96.46	$159.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.34 / $22.13 / $32.09	Professional	26	$12.34	$22.13	$32.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.70 / $69.19 / $99.98	Professional	TC	$40.70	$69.19	$99.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $107.20 / $126.10 / $131.10	Professional		$107.20	$126.10	$131.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $22.10 / $26.00 / $27.00	Professional	26	$22.10	$26.00	$27.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $85.10 / $100.10 / $104.10	Professional	TC	$85.10	$100.10	$104.10