Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $121.57 / $121.57 / $121.57	Facility	26	$121.57	$121.57	$121.57
Aetna Facility/Professional Facility Modifier 53 Low / Median / High Price $168.91 / $168.91 / $168.91	Facility	53	$168.91	$168.91	$168.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $749.17 / $954.60 / $1,427.32	Professional		$749.17	$954.60	$1,427.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.66 / $187.33 / $685.30	Professional	26	$111.66	$187.33	$685.30
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $374.59 / $374.59 / $422.27	Professional	52	$374.59	$374.59	$422.27
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $149.83 / $149.83 / $168.91	Professional	53	$149.83	$149.83	$168.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $637.51 / $767.25 / $2,100.04	Professional	TC	$637.51	$767.25	$2,100.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,478.33 / $1,508.04 / $1,858.16	Professional		$1,478.33	$1,508.04	$1,858.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $199.65 / $232.93 / $287.01	Professional	26	$199.65	$232.93	$287.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,256.92 / $1,275.10 / $1,571.15	Professional	TC	$1,256.92	$1,275.10	$1,571.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,029.85 / $1,842.16 / $5,332.25	Professional		$1,029.85	$1,842.16	$5,332.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $185.34 / $273.08 / $1,044.83	Professional	26	$185.34	$273.08	$1,044.83
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $938.15 / $1,563.58 / $4,416.72	Professional	TC	$938.15	$1,563.58	$4,416.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,052.00 / $1,680.21 / $2,185.59	Professional		$1,052.00	$1,680.21	$2,185.59
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $1,007.52 / $1,185.30 / $1,493.04	Professional		$1,007.52	$1,185.30	$1,493.04
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $154.09 / $208.55 / $316.79	Professional	26	$154.09	$208.55	$316.79
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $848.37 / $1,081.08 / $1,206.95	Professional	TC	$848.37	$1,081.08	$1,206.95
United Facility/Professional Professional Modifier Low / Median / High Price $986.40 / $1,449.67 / $1,872.48	Professional		$986.40	$1,449.67	$1,872.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $154.44 / $231.68 / $308.89	Professional	26	$154.44	$231.68	$308.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $804.89 / $1,333.72 / $1,582.76	Professional	TC	$804.89	$1,333.72	$1,582.76
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,317.00 / $1,549.40 / $1,611.40	Professional		$1,317.00	$1,549.40	$1,611.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $208.00 / $244.80 / $254.60	Professional	26	$208.00	$244.80	$254.60
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,109.00 / $1,304.70 / $1,356.80	Professional	TC	$1,109.00	$1,304.70	$1,356.80