Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $60.23 / $819.77 / $1,054.04	Facility		$60.23	$819.77	$1,054.04
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.60 / $30.60 / $30.60	Facility	26	$30.60	$30.60	$30.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.90 / $201.18 / $240.65	Professional		$51.90	$201.18	$240.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.01 / $51.90 / $131.40	Professional	26	$29.01	$51.90	$131.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.63 / $170.38 / $342.90	Professional	TC	$29.63	$170.38	$342.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.83 / $137.30 / $171.62	Professional		$89.83	$137.30	$171.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.17 / $69.04 / $86.30	Professional	26	$45.17	$69.04	$86.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.66 / $68.26 / $85.33	Professional	TC	$44.66	$68.26	$85.33
Medica Facility/Professional Facility Modifier Low / Median / High Price $84.68 / $101.79 / $340.01	Facility		$84.68	$101.79	$340.01
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.50 / $106.47 / $947.00	Professional		$60.50	$106.47	$947.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $35.61 / $58.83 / $368.00	Professional	26	$35.61	$58.83	$368.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $30.45 / $47.64 / $758.00	Professional	TC	$30.45	$47.64	$758.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $114.79 / $136.35 / $293.00	Facility		$114.79	$136.35	$293.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $107.73 / $107.73 / $107.73	Facility	26	$107.73	$107.73	$107.73
Midlands Facility/Professional Professional Modifier Low / Median / High Price $117.75 / $128.97 / $171.86	Professional		$117.75	$128.97	$171.86
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $72.94 / $100.28 / $174.18	Professional		$72.94	$100.28	$174.18
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $37.68 / $51.07 / $58.22	Professional	26	$37.68	$51.07	$58.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.60 / $47.84 / $104.51	Professional	TC	$32.60	$47.84	$104.51
United Facility/Professional Professional Modifier Low / Median / High Price $66.55 / $105.82 / $164.51	Professional		$66.55	$105.82	$164.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.82 / $42.29 / $64.73	Professional	26	$33.82	$42.29	$64.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $37.42 / $59.07	Professional	TC	$30.90	$37.42	$59.07
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $104.90 / $123.50 / $123.50	Professional		$104.90	$123.50	$123.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $53.40 / $62.80 / $62.80	Professional	26	$53.40	$62.80	$62.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $51.60 / $60.70 / $60.70	Professional	TC	$51.60	$60.70	$60.70