Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.93 / $90.93 / $90.93	Facility	26	$90.93	$90.93	$90.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $242.23 / $438.26 / $624.48	Professional		$242.23	$438.26	$624.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.95 / $87.48 / $137.63	Professional	26	$78.95	$87.48	$137.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $163.27 / $350.77 / $508.96	Professional	TC	$163.27	$350.77	$508.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $580.67 / $769.49 / $961.87	Professional		$580.67	$769.49	$961.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $165.57 / $202.46 / $253.07	Professional	26	$165.57	$202.46	$253.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $391.39 / $567.04 / $708.80	Professional	TC	$391.39	$567.04	$708.80
Medica Facility/Professional Professional Modifier Low / Median / High Price $428.74 / $662.60 / $2,878.66	Professional		$428.74	$662.60	$2,878.66
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $112.74 / $173.81 / $561.99	Professional	26	$112.74	$173.81	$561.99
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $315.32 / $488.79 / $2,400.63	Professional	TC	$315.32	$488.79	$2,400.63
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $299.55 / $299.55 / $299.55	Facility	26	$299.55	$299.55	$299.55
Midlands Facility/Professional Professional Modifier Low / Median / High Price $562.07 / $654.37 / $916.35	Professional		$562.07	$654.37	$916.35
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $422.20 / $562.85 / $638.97	Professional		$422.20	$562.85	$638.97
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $114.98 / $150.93 / $172.08	Professional	26	$114.98	$150.93	$172.08
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $307.20 / $409.55 / $470.35	Professional	TC	$307.20	$409.55	$470.35
United Facility/Professional Professional Modifier Low / Median / High Price $397.06 / $662.60 / $750.29	Professional		$397.06	$662.60	$750.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $105.46 / $169.11 / $201.19	Professional	26	$105.46	$169.11	$201.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $291.60 / $475.58 / $528.24	Professional	TC	$291.60	$475.58	$528.24
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $630.79 / $742.20 / $742.20	Professional		$630.79	$742.20	$742.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $170.70 / $200.80 / $200.80	Professional	26	$170.70	$200.80	$200.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $460.10 / $541.29 / $541.29	Professional	TC	$460.10	$541.29	$541.29