Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.23 / $120.23 / $120.23	Facility	26	$120.23	$120.23	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $954.99 / $2,884.03	Professional		$707.95	$954.99	$2,884.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $186.21 / $602.56	Professional	26	$107.15	$186.21	$602.56
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $630.96 / $977.24 / $1,071.52	Professional	52	$630.96	$977.24	$1,071.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $741.31 / $2,089.30	Professional	TC	$588.84	$741.31	$2,089.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,548.82 / $1,905.46	Professional		$1,513.56	$1,548.82	$1,905.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $234.42 / $234.42 / $295.12	Professional	26	$234.42	$234.42	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,288.25 / $1,288.25 / $1,621.81	Professional	TC	$1,288.25	$1,288.25	$1,621.81
Medica Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,513.56 / $2,630.27	Professional		$794.33	$1,513.56	$2,630.27
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $234.42 / $1,047.13	Professional	26	$154.88	$234.42	$1,047.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $1,318.26 / $4,466.84	Professional	TC	$776.25	$1,318.26	$4,466.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,778.28 / $1,995.26	Professional		$1,659.59	$1,778.28	$1,995.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $275.42 / $288.40	Professional	26	$257.04	$275.42	$288.40
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,412.54 / $1,479.11 / $1,698.24	Professional	TC	$1,412.54	$1,479.11	$1,698.24
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Professional		$1,778.28	$1,778.28	$1,778.28
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Professional	26	$263.03	$263.03	$263.03
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,479.11 / $1,479.11 / $1,479.11	Professional	TC	$1,479.11	$1,479.11	$1,479.11
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,174.90 / $1,479.11	Professional		$977.24	$1,174.90	$1,479.11
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $213.80 / $316.23	Professional	26	$141.25	$213.80	$316.23
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $1,071.52 / $1,230.27	Professional	TC	$831.76	$1,071.52	$1,230.27
United Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,513.56 / $1,995.26	Professional		$933.25	$1,513.56	$1,995.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $234.42 / $331.13	Professional	26	$154.88	$234.42	$331.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $776.25 / $1,288.25 / $1,698.24	Professional	TC	$776.25	$1,288.25	$1,698.24
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,548.82 / $1,621.81	Professional		$1,318.26	$1,548.82	$1,621.81
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $208.93 / $245.47 / $257.04	Professional	26	$208.93	$245.47	$257.04
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,096.48 / $1,318.26 / $1,348.96	Professional	TC	$1,096.48	$1,318.26	$1,348.96