Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $323.59 / $512.86	Facility		$134.90	$323.59	$512.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $10.00	Facility	26	$10.00	$10.00	$10.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $223.87 / $245.47	Facility	TC	$30.20	$223.87	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $52.48 / $114.82	Professional		$36.31	$52.48	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $16.60 / $38.02	Professional	26	$10.00	$16.60	$38.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $44.67 / $114.82	Professional	TC	$25.70	$44.67	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $95.50 / $117.49	Professional		$75.86	$95.50	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.55 / $30.90	Professional	26	$19.50	$24.55	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $69.18 / $87.10	Professional	TC	$56.23	$69.18	$87.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $60.26 / $354.81	Facility		$43.65	$60.26	$354.81
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $331.13 / $331.13 / $346.74	Facility	TC	$331.13	$331.13	$346.74
Medica Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $48.98 / $93.33	Professional		$33.11	$48.98	$93.33
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $19.50 / $30.20	Professional	26	$12.30	$19.50	$30.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $34.67 / $194.98	Professional	TC	$22.91	$34.67	$194.98
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $81.28 / $85.11	Professional		$77.62	$81.28	$85.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $22.91 / $26.30	Professional	26	$21.38	$22.91	$26.30
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $56.23 / $61.66	Professional	TC	$54.95	$56.23	$61.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $23.44 / $23.44	Professional	26	$23.44	$23.44	$23.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	TC	$54.95	$54.95	$54.95
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $56.23 / $77.62	Professional		$40.74	$56.23	$77.62
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $18.20 / $20.89	Professional	26	$13.18	$18.20	$20.89
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $40.74 / $56.23	Professional	TC	$29.51	$40.74	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $56.23 / $83.18	Professional		$38.02	$56.23	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $18.62 / $24.55	Professional	26	$11.48	$18.62	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.90 / $57.54	Professional	TC	$25.70	$38.90	$57.54
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $79.43	Professional		$67.61	$79.43	$79.43
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $21.38 / $21.38	Professional	26	$18.20	$21.38	$21.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $58.88 / $58.88	Professional	TC	$50.12	$58.88	$58.88