Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $295.12 / $457.09	Facility		$104.71	$295.12	$457.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $7.94 / $8.91	Facility	26	$7.94	$7.94	$8.91
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.20 / $123.03 / $354.81	Facility	TC	$18.20	$123.03	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $28.18 / $81.28	Professional		$20.89	$28.18	$81.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $8.91 / $28.18	Professional	26	$7.94	$8.91	$28.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $19.50 / $47.86	Professional	TC	$15.14	$19.50	$47.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $61.66 / $75.86	Professional		$48.98	$61.66	$75.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $19.95 / $24.55	Professional	26	$15.85	$19.95	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $41.69 / $51.29	Professional	TC	$29.51	$41.69	$51.29
Medica Facility/Professional Facility Modifier Low / Median / High Price $28.84 / $77.62 / $398.11	Facility		$28.84	$77.62	$398.11
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $281.84 / $281.84 / $281.84	Facility	TC	$281.84	$281.84	$281.84
Medica Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $30.90 / $54.95	Professional		$21.88	$30.90	$54.95
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $16.98 / $25.70	Professional	26	$10.72	$16.98	$25.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $12.02 / $19.95 / $30.20	Professional	TC	$12.02	$19.95	$30.20
Midlands Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $54.95 / $54.95	Professional		$50.12	$54.95	$54.95
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $18.62 / $21.38	Professional	26	$16.98	$18.62	$21.38
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $33.88 / $37.15	Professional	TC	$33.11	$33.88	$37.15
Midlands Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $52.48	Professional		$52.48	$52.48	$52.48
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $19.05	Professional	26	$19.05	$19.05	$19.05
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	TC	$33.88	$33.88	$33.88
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $42.66 / $50.12	Professional		$30.20	$42.66	$50.12
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.79 / $16.98	Professional	26	$10.47	$14.79	$16.98
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $29.51 / $33.88	Professional	TC	$20.42	$29.51	$33.88
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $33.11 / $53.70	Professional		$22.39	$33.11	$53.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.45 / $19.50	Professional	26	$10.00	$14.45	$19.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $20.89 / $30.20	Professional	TC	$12.59	$20.89	$30.20
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $52.48 / $52.48	Professional		$44.67	$52.48	$52.48
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $17.38 / $17.38	Professional	26	$14.79	$17.38	$17.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $34.67 / $34.67	Professional	TC	$29.51	$34.67	$34.67