Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.61 / $128.61 / $128.61	Facility	26	$128.61	$128.61	$128.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $636.75 / $720.28 / $1,077.18	Professional		$636.75	$720.28	$1,077.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $111.15 / $132.19 / $463.37	Professional	26	$111.15	$132.19	$463.37
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $285.27 / $318.38 / $343.82	Professional	52	$285.27	$318.38	$343.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $519.69 / $602.07 / $913.09	Professional	TC	$519.69	$602.07	$913.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,306.91 / $1,309.57 / $1,636.96	Professional		$1,306.91	$1,309.57	$1,636.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $235.44 / $237.79 / $294.89	Professional	26	$235.44	$237.79	$294.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,071.47 / $1,073.66 / $1,342.07	Professional	TC	$1,071.47	$1,073.66	$1,342.07
Medica Facility/Professional Professional Modifier Low / Median / High Price $626.94 / $1,161.23 / $6,200.00	Professional		$626.94	$1,161.23	$6,200.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $133.97 / $243.58 / $2,600.00	Professional	26	$133.97	$243.58	$2,600.00
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $505.15 / $1,010.30 / $7,000.00	Professional	TC	$505.15	$1,010.30	$7,000.00
Midlands Facility/Professional Professional Modifier Low / Median / High Price $982.52 / $1,218.94 / $1,543.44	Professional		$982.52	$1,218.94	$1,543.44
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $738.06 / $1,004.92 / $1,216.82	Professional		$738.06	$1,004.92	$1,216.82
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $139.76 / $196.89 / $224.47	Professional	26	$139.76	$196.89	$224.47
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $596.95 / $807.25 / $992.34	Professional	TC	$596.95	$807.25	$992.34
United Facility/Professional Professional Modifier Low / Median / High Price $689.63 / $1,109.77 / $1,304.54	Professional		$689.63	$1,109.77	$1,304.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $133.97 / $214.81 / $257.17	Professional	26	$133.97	$214.81	$257.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $505.15 / $881.93 / $1,162.45	Professional	TC	$505.15	$881.93	$1,162.45
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,255.09 / $1,535.60 / $1,535.60	Professional		$1,255.09	$1,535.60	$1,535.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $231.50 / $283.30 / $283.30	Professional	26	$231.50	$283.30	$283.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,023.60 / $1,252.40 / $1,252.40	Professional	TC	$1,023.60	$1,252.40	$1,252.40