Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $1,819.70 / $2,754.23	Facility		$630.96	$1,819.70	$2,754.23
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $331.13 / $331.13	Facility	26	$74.13	$331.13	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $331.13 / $602.56	Professional		$181.97	$331.13	$602.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $69.18 / $165.96	Professional	26	$64.57	$69.18	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $208.93 / $954.99	Professional	TC	$117.49	$208.93	$954.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $416.87 / $524.81	Professional		$380.19	$416.87	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $144.54 / $177.83	Professional	26	$131.83	$144.54	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $275.42 / $346.74	Professional	TC	$251.19	$275.42	$346.74
Medica Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $446.68 / $2,454.71	Facility		$288.40	$446.68	$2,454.71
Medica Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $380.19 / $3,981.07	Professional		$194.98	$380.19	$3,981.07
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $128.82 / $436.52	Professional	26	$70.79	$128.82	$436.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $288.40 / $1,000.00	Professional	TC	$165.96	$288.40	$1,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $398.11 / $457.09	Professional		$398.11	$398.11	$457.09
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $144.54 / $147.91	Professional	26	$144.54	$144.54	$147.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $251.19 / $302.00	Professional	TC	$251.19	$251.19	$302.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $371.54 / $426.58	Professional		$245.47	$371.54	$426.58
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $112.20 / $144.54	Professional	26	$79.43	$112.20	$144.54
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $245.47 / $281.84	Professional	TC	$162.18	$245.47	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $371.54 / $501.19	Professional		$213.80	$371.54	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $120.23 / $154.88	Professional	26	$72.44	$120.23	$154.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $245.47 / $363.08	Professional	TC	$141.25	$245.47	$363.08
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $457.09 / $478.63	Professional		$389.05	$457.09	$478.63
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $158.49 / $165.96	Professional	26	$134.90	$158.49	$165.96
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $295.12 / $309.03	Professional	TC	$251.19	$295.12	$309.03