Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $114.60 / $647.09 / $1,098.90	Facility		$114.60	$647.09	$1,098.90
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.53 / $35.53 / $35.53	Facility	26	$35.53	$35.53	$35.53
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $79.06 / $296.58 / $427.57	Facility	TC	$79.06	$296.58	$427.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.51 / $133.18 / $195.31	Professional		$97.51	$133.18	$195.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.84 / $34.96 / $97.01	Professional	26	$32.84	$34.96	$97.01
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $48.76 / $48.76 / $163.19	Professional	52	$48.76	$48.76	$163.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.14 / $109.52 / $263.70	Professional	TC	$72.14	$109.52	$263.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.94 / $252.10 / $315.13	Professional		$164.94	$252.10	$315.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.77 / $79.12 / $98.90	Professional	26	$51.77	$79.12	$98.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.17 / $172.98 / $216.23	Professional	TC	$113.17	$172.98	$216.23
Medica Facility/Professional Facility Modifier Low / Median / High Price $154.91 / $187.67 / $823.34	Facility		$154.91	$187.67	$823.34
Medica Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $211.29 / $704.47	Professional		$115.13	$211.29	$704.47
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $40.49 / $68.17 / $290.60	Professional	26	$40.49	$68.17	$290.60
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $85.44 / $143.12 / $483.33	Professional	TC	$85.44	$143.12	$483.33
Midlands Facility/Professional Facility Modifier Low / Median / High Price $203.10 / $251.68 / $365.68	Facility		$203.10	$251.68	$365.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $117.30 / $117.30 / $117.30	Facility	26	$117.30	$117.30	$117.30
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $321.85 / $321.85 / $321.85	Facility	TC	$321.85	$321.85	$321.85
Midlands Facility/Professional Professional Modifier Low / Median / High Price $203.00 / $251.68 / $277.43	Professional		$203.00	$251.68	$277.43
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $132.55 / $183.27 / $208.95	Professional		$132.55	$183.27	$208.95
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.55 / $59.01 / $67.28	Professional	26	$43.55	$59.01	$67.28
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $86.84 / $124.26 / $141.66	Professional	TC	$86.84	$124.26	$141.66
United Facility/Professional Professional Modifier Low / Median / High Price $125.93 / $169.87 / $228.96	Professional		$125.93	$169.87	$228.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.49 / $48.14 / $77.30	Professional	26	$40.49	$48.14	$77.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.44 / $139.25 / $163.11	Professional	TC	$85.44	$139.25	$163.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $191.50 / $225.30 / $225.30	Professional		$191.50	$225.30	$225.30
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $61.70 / $72.50 / $72.50	Professional	26	$61.70	$72.50	$72.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $129.80 / $152.80 / $152.80	Professional	TC	$129.80	$152.80	$152.80