Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.06 / $345.23 / $695.64	Facility		$95.06	$345.23	$695.64
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.64 / $10.64 / $10.64	Facility	26	$10.64	$10.64	$10.64
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $117.15 / $245.74 / $404.81	Facility	TC	$117.15	$245.74	$404.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.80 / $35.29 / $102.60	Professional		$29.80	$35.29	$102.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.83 / $10.82 / $36.49	Professional	26	$9.83	$10.82	$36.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.02 / $33.09 / $174.60	Professional	TC	$21.02	$33.09	$174.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.06 / $78.34 / $97.93	Professional		$64.06	$78.34	$97.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.03 / $23.27 / $29.09	Professional	26	$19.03	$23.27	$29.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.11 / $55.07 / $68.84	Professional	TC	$44.11	$55.07	$68.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $37.11 / $59.64 / $440.83	Facility		$37.11	$59.64	$440.83
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $471.82 / $471.82 / $471.82	Facility	TC	$471.82	$471.82	$471.82
Medica Facility/Professional Professional Modifier Low / Median / High Price $35.00 / $60.59 / $215.20	Professional		$35.00	$60.59	$215.20
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.95 / $21.39 / $26.54	Professional	26	$13.95	$21.39	$26.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $39.04 / $149.15	Professional	TC	$23.42	$39.04	$149.15
Midlands Facility/Professional Facility Modifier Low / Median / High Price $52.45 / $70.22 / $114.35	Facility		$52.45	$70.22	$114.35
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $36.67 / $36.67 / $36.67	Facility	26	$36.67	$36.67	$36.67
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $65.03 / $65.03 / $65.03	Facility	TC	$65.03	$65.03	$65.03
Midlands Facility/Professional Professional Modifier Low / Median / High Price $67.06 / $70.22 / $86.02	Professional		$67.06	$70.22	$86.02
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $41.04 / $57.31 / $65.34	Professional		$41.04	$57.31	$65.34
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.17 / $17.59 / $20.05	Professional	26	$11.17	$17.59	$20.05
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $23.72 / $39.72 / $45.28	Professional	TC	$23.72	$39.72	$45.28
United Facility/Professional Professional Modifier Low / Median / High Price $36.54 / $51.73 / $66.11	Professional		$36.54	$51.73	$66.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.38 / $17.05 / $22.91	Professional	26	$12.38	$17.05	$22.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.42 / $39.04 / $66.06	Professional	TC	$23.42	$39.04	$66.06
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $57.70 / $67.80 / $67.80	Professional		$57.70	$67.80	$67.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $17.70 / $20.80 / $20.80	Professional	26	$17.70	$20.80	$20.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $40.00 / $47.00 / $47.00	Professional	TC	$40.00	$47.00	$47.00