Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $109.65	Facility	26	$109.65	$109.65	$109.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $630.96 / $3,630.78	Professional		$436.52	$630.96	$3,630.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $147.91 / $338.84	Professional	26	$102.33	$147.91	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $457.09 / $891.25	Professional	TC	$338.84	$457.09	$891.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,148.15 / $1,445.44	Professional		$912.01	$1,148.15	$1,445.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $251.19 / $309.03	Professional	26	$199.53	$251.19	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $891.25 / $1,122.02	Professional	TC	$724.44	$891.25	$1,122.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $1,000.00 / $1,659.59	Professional		$501.19	$1,000.00	$1,659.59
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $190.55 / $933.25	Professional	26	$112.20	$190.55	$933.25
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $812.83 / $5,370.32	Professional	TC	$467.74	$812.83	$5,370.32
Midlands Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,023.29 / $1,096.48	Professional		$933.25	$1,023.29	$1,096.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $229.09 / $263.03	Professional	26	$213.80	$229.09	$263.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $794.33 / $831.76	Professional	TC	$724.44	$794.33	$831.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional		$1,000.00	$1,000.00	$1,000.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $234.42 / $234.42	Professional	26	$234.42	$234.42	$234.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $776.25 / $776.25	Professional	TC	$776.25	$776.25	$776.25
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $933.25 / $1,174.90	Professional		$630.96	$933.25	$1,174.90
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $181.97 / $218.78	Professional	26	$131.83	$181.97	$218.78
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $707.95 / $1,023.29	Professional	TC	$489.78	$707.95	$1,023.29
United Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $1,000.00 / $1,348.96	Professional		$575.44	$1,000.00	$1,348.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $190.55 / $275.42	Professional	26	$112.20	$190.55	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $831.76 / $1,047.13	Professional	TC	$457.09	$831.76	$1,047.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,258.93 / $1,258.93	Professional		$1,071.52	$1,258.93	$1,258.93
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $281.84 / $281.84	Professional	26	$239.88	$281.84	$281.84
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $977.24 / $977.24	Professional	TC	$831.76	$977.24	$977.24