Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $387.76 / $387.76 / $2,290.00	Facility		$387.76	$387.76	$2,290.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $118.50 / $118.50 / $118.50	Facility	26	$118.50	$118.50	$118.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $370.30 / $384.65 / $597.26	Professional		$370.30	$384.65	$597.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.03 / $132.90 / $190.72	Professional	26	$106.03	$132.90	$190.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.19 / $237.40 / $406.52	Professional	TC	$223.19	$237.40	$406.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $783.11 / $836.75 / $1,045.94	Professional		$783.11	$836.75	$1,045.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $260.85 / $276.58 / $345.73	Professional	26	$260.85	$276.58	$345.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $510.71 / $560.16 / $700.22	Professional	TC	$510.71	$560.16	$700.22
Medica Facility/Professional Facility Modifier Low / Median / High Price $384.65 / $573.69 / $955.98	Facility		$384.65	$573.69	$955.98
Medica Facility/Professional Professional Modifier Low / Median / High Price $376.26 / $684.10 / $2,844.40	Professional		$376.26	$684.10	$2,844.40
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $151.72 / $252.86 / $930.32	Professional	26	$151.72	$252.86	$930.32
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $258.74 / $454.55 / $1,914.08	Professional	TC	$258.74	$454.55	$1,914.08
Midlands Facility/Professional Facility Modifier Low / Median / High Price $407.00 / $610.86 / $1,218.18	Facility		$407.00	$610.86	$1,218.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $551.36 / $783.11 / $1,040.06	Professional		$551.36	$783.11	$1,040.06
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $441.55 / $591.69 / $696.06	Professional		$441.55	$591.69	$696.06
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $156.97 / $211.19 / $241.29	Professional	26	$156.97	$211.19	$241.29
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $284.57 / $386.58 / $454.77	Professional	TC	$284.57	$386.58	$454.77
United Facility/Professional Facility Modifier Low / Median / High Price $1,643.00 / $1,643.00 / $1,643.00	Facility		$1,643.00	$1,643.00	$1,643.00
United Facility/Professional Professional Modifier Low / Median / High Price $376.26 / $684.10 / $1,060.98	Professional		$376.26	$684.10	$1,060.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.72 / $246.32 / $353.90	Professional	26	$151.72	$246.32	$353.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $280.44 / $539.04 / $707.08	Professional	TC	$280.44	$539.04	$707.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $690.50 / $812.40 / $844.90	Professional		$690.50	$812.40	$844.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.40 / $281.60 / $292.89	Professional	26	$239.40	$281.60	$292.89
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $451.20 / $530.79 / $552.00	Professional	TC	$451.20	$530.79	$552.00