Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,137.96 / $4,466.84	Professional		$1,905.46	$2,137.96	$4,466.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $398.11 / $436.52 / $1,202.26	Professional	26	$398.11	$436.52	$1,202.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,513.56 / $1,778.28 / $4,677.35	Professional	TC	$1,513.56	$1,778.28	$4,677.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $4,073.80 / $4,466.84 / $5,623.41	Professional		$4,073.80	$4,466.84	$5,623.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $912.01 / $1,000.00 / $1,258.93	Professional	26	$912.01	$1,000.00	$1,258.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $3,162.28 / $3,467.37 / $4,365.16	Professional	TC	$3,162.28	$3,467.37	$4,365.16
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,570.40 / $4,365.16	Professional		$1,778.28	$2,570.40	$4,365.16
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $398.11 / $660.69 / $2,187.76	Professional	26	$398.11	$660.69	$2,187.76
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $1,288.25 / $2,041.74 / $3,311.31	Professional	TC	$1,288.25	$2,041.74	$3,311.31
Midlands Facility/Professional Professional Modifier Low / Median / High Price $4,365.16 / $4,365.16 / $4,365.16	Professional		$4,365.16	$4,365.16	$4,365.16
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $977.24 / $977.24 / $977.24	Professional	26	$977.24	$977.24	$977.24
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Professional	TC	$3,388.44	$3,388.44	$3,388.44
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $3,162.28 / $3,630.78	Professional		$2,398.83	$3,162.28	$3,630.78
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $501.19 / $691.83 / $812.83	Professional	26	$501.19	$691.83	$812.83
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $1,862.09 / $2,511.89 / $2,754.23	Professional	TC	$1,862.09	$2,511.89	$2,754.23
United Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,884.03 / $4,265.80	Professional		$2,187.76	$2,884.03	$4,265.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $457.09 / $660.69 / $933.25	Professional	26	$457.09	$660.69	$933.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,698.24 / $2,187.76 / $3,388.44	Professional	TC	$1,698.24	$2,187.76	$3,388.44
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $3,388.44 / $4,073.80 / $4,073.80	Professional		$3,388.44	$4,073.80	$4,073.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $776.25 / $912.01 / $912.01	Professional	26	$776.25	$912.01	$912.01
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $2,630.27 / $3,090.30 / $3,090.30	Professional	TC	$2,630.27	$3,090.30	$3,090.30