Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.76 / $217.80 / $463.58	Professional		$51.76	$217.80	$463.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.72 / $69.56 / $288.00	Professional	26	$34.72	$69.56	$288.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $25.88 / $25.88 / $25.88	Professional	52	$25.88	$25.88	$25.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.45 / $119.26 / $603.00	Professional	TC	$34.45	$119.26	$603.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $94.57 / $125.17 / $190.69	Professional		$94.57	$125.17	$190.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.07 / $63.72 / $109.20	Professional	26	$47.07	$63.72	$109.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.00 / $59.38 / $95.78	Professional	TC	$28.00	$59.38	$95.78
Medica Facility/Professional Facility Modifier Low / Median / High Price $79.94 / $114.78 / $189.05	Facility		$79.94	$114.78	$189.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.60 / $128.49 / $188.83	Professional		$42.60	$128.49	$188.83
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $31.52 / $78.80 / $155.72	Professional	26	$31.52	$78.80	$155.72
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $94.79 / $349.50	Professional	TC	$19.13	$94.79	$349.50
Midlands Facility/Professional Facility Modifier Low / Median / High Price $83.89 / $157.75 / $283.07	Facility		$83.89	$157.75	$283.07
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $139.31 / $139.31 / $139.31	Facility	26	$139.31	$139.31	$139.31
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $143.77 / $143.77 / $143.77	Facility	TC	$143.77	$143.77	$143.77
Midlands Facility/Professional Professional Modifier Low / Median / High Price $120.54 / $125.17 / $170.00	Professional		$120.54	$125.17	$170.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $87.53 / $121.99 / $160.37	Professional		$87.53	$121.99	$160.37
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $44.80 / $61.28 / $69.87	Professional	26	$44.80	$61.28	$69.87
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.76 / $60.71 / $101.66	Professional	TC	$40.76	$60.71	$101.66
United Facility/Professional Professional Modifier Low / Median / High Price $42.60 / $42.94 / $137.94	Professional		$42.60	$42.94	$137.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.57 / $23.47 / $78.80	Professional	26	$21.57	$23.47	$78.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.13 / $21.37 / $79.56	Professional	TC	$19.13	$21.37	$79.56
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $122.00 / $157.00 / $168.80	Professional		$122.00	$157.00	$168.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $61.30 / $78.80 / $84.80	Professional	26	$61.30	$78.80	$84.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $60.70 / $78.09 / $84.00	Professional	TC	$60.70	$78.09	$84.00