Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.57 / $613.04 / $852.98	Facility		$117.57	$613.04	$852.98
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.47 / $27.47 / $27.47	Facility	26	$27.47	$27.47	$27.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.34 / $131.79 / $399.60	Professional		$107.34	$131.79	$399.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.28 / $39.50 / $94.34	Professional	26	$25.28	$39.50	$94.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $49.76 / $49.76 / $93.90	Professional	52	$49.76	$49.76	$93.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.91 / $131.41 / $304.20	Professional	TC	$79.91	$131.41	$304.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $168.49 / $257.52 / $321.92	Professional		$168.49	$257.52	$321.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.09 / $61.28 / $76.59	Professional	26	$40.09	$61.28	$76.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.40 / $196.25 / $245.32	Professional	TC	$128.40	$196.25	$245.32
Medica Facility/Professional Facility Modifier Low / Median / High Price $130.24 / $192.88 / $677.77	Facility		$130.24	$192.88	$677.77
Medica Facility/Professional Professional Modifier Low / Median / High Price $118.01 / $216.64 / $726.73	Professional		$118.01	$216.64	$726.73
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $52.16 / $255.92	Professional	26	$30.87	$52.16	$255.92
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $89.86 / $164.48 / $554.94	Professional	TC	$89.86	$164.48	$554.94
Midlands Facility/Professional Facility Modifier Low / Median / High Price $206.23 / $256.27 / $371.35	Facility		$206.23	$256.27	$371.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $87.85 / $87.85 / $87.85	Facility	26	$87.85	$87.85	$87.85
Midlands Facility/Professional Professional Modifier Low / Median / High Price $149.00 / $243.06 / $286.00	Professional		$149.00	$243.06	$286.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $127.21 / $186.11 / $212.18	Professional		$127.21	$186.11	$212.18
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $33.90 / $45.39 / $51.75	Professional	26	$33.90	$45.39	$51.75
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $98.26 / $140.72 / $160.43	Professional	TC	$98.26	$140.72	$160.43
United Facility/Professional Professional Modifier Low / Median / High Price $121.20 / $153.58 / $235.84	Professional		$121.20	$153.58	$235.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $43.84 / $57.27	Professional	26	$30.87	$43.84	$57.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.84 / $160.04 / $179.72	Professional	TC	$98.84	$160.04	$179.72
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $194.50 / $228.80 / $228.80	Professional		$194.50	$228.80	$228.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $47.40 / $55.80 / $55.80	Professional	26	$47.40	$55.80	$55.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $147.00 / $173.00 / $173.00	Professional	TC	$147.00	$173.00	$173.00