Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $294.19 / $294.19 / $294.19	Facility	26	$294.19	$294.19	$294.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,068.84 / $1,151.59 / $1,658.93	Professional		$1,068.84	$1,151.59	$1,658.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $259.62 / $294.19 / $781.42	Professional	26	$259.62	$294.19	$781.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $779.44 / $857.38 / $1,249.33	Professional	TC	$779.44	$857.38	$1,249.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,065.09 / $2,094.96 / $2,581.36	Professional		$2,065.09	$2,094.96	$2,581.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $551.34 / $559.32 / $689.18	Professional	26	$551.34	$559.32	$689.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,513.75 / $1,535.65 / $1,892.18	Professional	TC	$1,513.75	$1,535.65	$1,892.18
Medica Facility/Professional Professional Modifier Low / Median / High Price $1,200.18 / $2,000.30 / $6,888.39	Professional		$1,200.18	$2,000.30	$6,888.39
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $343.34 / $572.24 / $1,791.90	Professional	26	$343.34	$572.24	$1,791.90
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $856.84 / $1,428.06 / $5,096.49	Professional	TC	$856.84	$1,428.06	$5,096.49
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,464.30 / $2,314.25 / $2,797.10	Professional		$1,464.30	$2,314.25	$2,797.10
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $1,275.78 / $1,689.15 / $1,974.60	Professional		$1,275.78	$1,689.15	$1,974.60
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $374.09 / $486.83 / $555.04	Professional	26	$374.09	$486.83	$555.04
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $901.70 / $1,202.32 / $1,432.61	Professional	TC	$901.70	$1,202.32	$1,432.61
United Facility/Professional Professional Modifier Low / Median / High Price $1,200.18 / $1,931.13 / $2,252.98	Professional		$1,200.18	$1,931.13	$2,252.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $343.34 / $556.07 / $600.86	Professional	26	$343.34	$556.07	$600.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $856.84 / $1,417.36 / $1,653.58	Professional	TC	$856.84	$1,417.36	$1,653.58
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,986.40 / $2,336.90 / $2,430.40	Professional		$1,986.40	$2,336.90	$2,430.40
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $572.50 / $673.50 / $700.50	Professional	26	$572.50	$673.50	$700.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,413.90 / $1,663.40 / $1,730.00	Professional	TC	$1,413.90	$1,663.40	$1,730.00