Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $131.83 / $131.83	Facility	26	$125.89	$131.83	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $741.31 / $1,819.70	Professional		$588.84	$741.31	$1,819.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $263.03 / $478.63	Professional	26	$114.82	$263.03	$478.63
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $257.04 / $257.04 / $257.04	Professional	52	$257.04	$257.04	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $588.84 / $1,174.90	Professional	TC	$478.63	$588.84	$1,174.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,380.38 / $1,698.24	Professional		$1,380.38	$1,380.38	$1,698.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $245.47 / $309.03	Professional	26	$245.47	$245.47	$309.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,122.02 / $1,122.02 / $1,412.54	Professional	TC	$1,122.02	$1,122.02	$1,412.54
Medica Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,047.13 / $6,165.95	Professional		$630.96	$1,047.13	$6,165.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $223.87 / $1,071.52	Professional	26	$125.89	$223.87	$1,071.52
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $851.14 / $3,890.45	Professional	TC	$537.03	$851.14	$3,890.45
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,288.25 / $1,584.89	Professional		$1,230.27	$1,288.25	$1,584.89
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $251.19 / $257.04 / $302.00	Professional	26	$251.19	$257.04	$302.00
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $977.24 / $1,047.13 / $1,258.93	Professional	TC	$977.24	$1,047.13	$1,258.93
Midlands Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,479.11	Professional		$1,288.25	$1,288.25	$1,479.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $257.04 / $281.84	Professional	26	$257.04	$257.04	$281.84
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $1,047.13 / $1,047.13 / $1,202.26	Professional	TC	$1,047.13	$1,047.13	$1,202.26
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,096.48 / $1,348.96	Professional		$776.25	$1,096.48	$1,348.96
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $208.93 / $245.47	Professional	26	$141.25	$208.93	$245.47
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $870.96 / $1,047.13	Professional	TC	$630.96	$870.96	$1,047.13
United Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,071.52 / $1,513.56	Professional		$724.44	$1,071.52	$1,513.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $223.87 / $269.15	Professional	26	$138.04	$223.87	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $851.14 / $1,258.93	Professional	TC	$588.84	$851.14	$1,258.93
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,621.81 / $1,621.81	Professional		$1,318.26	$1,621.81	$1,621.81
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $295.12 / $295.12	Professional	26	$239.88	$295.12	$295.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $1,071.52 / $1,318.26 / $1,318.26	Professional	TC	$1,071.52	$1,318.26	$1,318.26