Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $61.66 / $190.55 / $645.65	Facility		$61.66	$190.55	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $34.67 / $34.67	Facility	26	$34.67	$34.67	$34.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $81.28 / $251.19	Professional		$30.20	$81.28	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $38.90 / $104.71	Professional	26	$17.38	$38.90	$104.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $30.20 / $162.18	Professional	TC	$25.12	$30.20	$162.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $151.36 / $190.55	Professional		$134.90	$151.36	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $85.11 / $104.71	Professional	26	$75.86	$85.11	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $67.61 / $83.18	Professional	TC	$58.88	$67.61	$83.18
Medica Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $100.00 / $501.19	Facility		$58.88	$100.00	$501.19
Medica Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $117.49 / $1,318.26	Professional		$60.26	$117.49	$1,318.26
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $67.61 / $630.96	Professional	26	$41.69	$67.61	$630.96
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $53.70 / $870.96	Professional	TC	$34.67	$53.70	$870.96
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $154.88 / $158.49	Professional		$138.04	$154.88	$158.49
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $89.13 / $91.20	Professional	26	$79.43	$89.13	$91.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $67.61 / $67.61	Professional	TC	$58.88	$67.61	$67.61
Midlands Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $154.88	Professional		$138.04	$138.04	$154.88
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $85.11	Professional	26	$79.43	$79.43	$85.11
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $70.79	Professional	TC	$58.88	$58.88	$70.79
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $263.03	Professional		$74.13	$117.49	$263.03
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $70.79 / $125.89	Professional	26	$42.66	$70.79	$125.89
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $51.29 / $165.96	Professional	TC	$32.36	$51.29	$165.96
United Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $812.83 / $812.83	Facility		$812.83	$812.83	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $128.82 / $194.98	Professional		$83.18	$128.82	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $72.44 / $107.15	Professional	26	$44.67	$72.44	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $56.23 / $91.20	Professional	TC	$36.31	$56.23	$91.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $151.36	Professional		$123.03	$151.36	$151.36
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $85.11 / $85.11	Professional	26	$70.79	$85.11	$85.11
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $64.57 / $64.57	Professional	TC	$53.70	$64.57	$64.57