Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.34 / $64.34 / $64.34	Facility	26	$64.34	$64.34	$64.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $369.16 / $438.14 / $801.50	Professional		$369.16	$438.14	$801.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.71 / $64.34 / $122.98	Professional	26	$55.71	$64.34	$122.98
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $184.58 / $209.17 / $219.07	Professional	52	$184.58	$209.17	$219.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $313.45 / $373.79 / $694.30	Professional	TC	$313.45	$373.79	$694.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $863.49 / $866.63 / $1,081.57	Professional		$863.49	$866.63	$1,081.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.37 / $119.84 / $147.02	Professional	26	$117.37	$119.84	$147.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $746.12 / $750.68 / $934.55	Professional	TC	$746.12	$750.68	$934.55
Medica Facility/Professional Professional Modifier Low / Median / High Price $468.75 / $810.53 / $2,899.13	Professional		$468.75	$810.53	$2,899.13
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $62.22 / $124.44 / $873.43	Professional	26	$62.22	$124.44	$873.43
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $406.53 / $733.87 / $2,483.58	Professional	TC	$406.53	$733.87	$2,483.58
Midlands Facility/Professional Professional Modifier Low / Median / High Price $684.00 / $829.34 / $1,020.85	Professional		$684.00	$829.34	$1,020.85
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $469.68 / $682.98 / $803.45	Professional		$469.68	$682.98	$803.45
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $70.08 / $98.16 / $111.91	Professional	26	$70.08	$98.16	$111.91
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $399.32 / $587.84 / $691.54	Professional	TC	$399.32	$587.84	$691.54
United Facility/Professional Professional Modifier Low / Median / High Price $468.75 / $734.49 / $984.38	Professional		$468.75	$734.49	$984.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.22 / $110.71 / $130.66	Professional	26	$62.22	$110.71	$130.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $406.53 / $623.78 / $1,016.33	Professional	TC	$406.53	$623.78	$1,016.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $828.70 / $1,014.00 / $1,014.00	Professional		$828.70	$1,014.00	$1,014.00
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $115.40 / $141.19 / $141.19	Professional	26	$115.40	$141.19	$141.19
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $713.30 / $872.70 / $872.70	Professional	TC	$713.30	$872.70	$872.70