Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.94 / $113.94 / $113.94	Facility	26	$113.94	$113.94	$113.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $262.49 / $461.44 / $507.59	Professional		$262.49	$461.44	$507.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.44 / $172.62 / $304.38	Professional	26	$105.44	$172.62	$304.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $163.27 / $350.63 / $364.43	Professional	TC	$163.27	$350.63	$364.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $641.48 / $980.48 / $1,225.60	Professional		$641.48	$980.48	$1,225.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $207.44 / $253.65 / $317.07	Professional	26	$207.44	$253.65	$317.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $475.53 / $726.83 / $908.54	Professional	TC	$475.53	$726.83	$908.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $459.83 / $766.38 / $4,801.00	Professional		$459.83	$766.38	$4,801.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $142.07 / $219.02 / $1,632.94	Professional	26	$142.07	$219.02	$1,632.94
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $317.05 / $554.84 / $3,601.00	Professional	TC	$317.05	$554.84	$3,601.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $376.67 / $376.67 / $376.67	Facility	26	$376.67	$376.67	$376.67
Midlands Facility/Professional Professional Modifier Low / Median / High Price $612.36 / $711.42 / $1,150.68	Professional		$612.36	$711.42	$1,150.68
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $464.26 / $687.92 / $809.27	Professional		$464.26	$687.92	$809.27
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $137.87 / $189.51 / $216.06	Professional	26	$137.87	$189.51	$216.06
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $318.54 / $504.26 / $593.21	Professional	TC	$318.54	$504.26	$593.21
United Facility/Professional Professional Modifier Low / Median / High Price $504.90 / $766.38 / $922.94	Professional		$504.90	$766.38	$922.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.61 / $213.11 / $249.86	Professional	26	$132.61	$213.11	$249.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $372.29 / $528.41 / $608.98	Professional	TC	$372.29	$528.41	$608.98
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $802.80 / $944.50 / $944.50	Professional		$802.80	$944.50	$944.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $214.30 / $252.20 / $252.20	Professional	26	$214.30	$252.20	$252.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $588.50 / $692.30 / $692.30	Professional	TC	$588.50	$692.30	$692.30