Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $122.92 / $713.68 / $1,027.79	Facility		$122.92	$713.68	$1,027.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.13 / $27.13 / $27.13	Facility	26	$27.13	$27.13	$27.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $82.68 / $192.58	Professional		$67.84	$82.68	$192.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.28 / $33.45 / $94.34	Professional	26	$25.28	$33.45	$94.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.89 / $68.95 / $206.28	Professional	TC	$49.89	$68.95	$206.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.86 / $267.62 / $334.52	Professional		$218.86	$267.62	$334.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.48 / $60.50 / $75.63	Professional	26	$49.48	$60.50	$75.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.22 / $207.11 / $258.89	Professional	TC	$161.22	$207.11	$258.89
Medica Facility/Professional Facility Modifier Low / Median / High Price $110.19 / $176.89 / $638.53	Facility		$110.19	$176.89	$638.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $109.50 / $195.93 / $752.82	Professional		$109.50	$195.93	$752.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $33.40 / $50.10 / $169.69	Professional	26	$33.40	$50.10	$169.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $78.55 / $146.38 / $583.14	Professional	TC	$78.55	$146.38	$583.14
Midlands Facility/Professional Facility Modifier Low / Median / High Price $139.00 / $225.97 / $386.05	Facility		$139.00	$225.97	$386.05
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $87.57 / $87.57 / $87.57	Facility	26	$87.57	$87.57	$87.57
Midlands Facility/Professional Professional Modifier Low / Median / High Price $140.00 / $225.64 / $299.60	Professional		$140.00	$225.64	$299.60
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $118.61 / $181.17 / $220.59	Professional		$118.61	$181.17	$220.59
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $32.90 / $44.82 / $51.11	Professional	26	$32.90	$44.82	$51.11
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $89.52 / $127.42 / $169.49	Professional	TC	$89.52	$127.42	$169.49
United Facility/Professional Professional Modifier Low / Median / High Price $102.63 / $170.33 / $201.95	Professional		$102.63	$170.33	$201.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.26 / $50.10 / $56.55	Professional	26	$26.26	$50.10	$56.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.55 / $126.17 / $150.46	Professional	TC	$78.55	$126.17	$150.46
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $193.50 / $227.60 / $227.60	Professional		$193.50	$227.60	$227.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $44.80 / $52.70 / $52.70	Professional	26	$44.80	$52.70	$52.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $148.69 / $174.90 / $174.90	Professional	TC	$148.69	$174.90	$174.90