Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $70.98 / $368.92 / $632.01	Facility		$70.98	$368.92	$632.01
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.99 / $10.99 / $10.99	Facility	26	$10.99	$10.99	$10.99
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.70 / $225.30 / $245.74	Facility	TC	$30.70	$225.30	$245.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.67 / $41.70 / $111.25	Professional		$35.67	$41.70	$111.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.15 / $14.41 / $38.70	Professional	26	$10.15	$14.41	$38.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.17 / $43.92 / $186.90	Professional	TC	$26.17	$43.92	$186.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.48 / $92.31 / $115.39	Professional		$75.48	$92.31	$115.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.67 / $24.05 / $30.06	Professional	26	$19.67	$24.05	$30.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.68 / $68.26 / $85.33	Professional	TC	$54.68	$68.26	$85.33
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.80 / $60.28 / $129.60	Facility		$43.80	$60.28	$129.60
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $332.01 / $332.01 / $345.29	Facility	TC	$332.01	$332.01	$345.29
Medica Facility/Professional Professional Modifier Low / Median / High Price $38.19 / $68.69 / $254.22	Professional		$38.19	$68.69	$254.22
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.53 / $20.95 / $90.81	Professional	26	$13.53	$20.95	$90.81
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.00 / $45.50 / $195.00	Professional	TC	$26.00	$45.50	$195.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $66.00 / $81.18 / $134.72	Facility		$66.00	$81.18	$134.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $36.81 / $36.81 / $36.81	Facility	26	$36.81	$36.81	$36.81
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $93.33 / $93.33 / $93.33	Facility	TC	$93.33	$93.33	$93.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $62.00 / $81.18 / $100.09	Professional		$62.00	$81.18	$100.09
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $40.06 / $57.39 / $76.98	Professional		$40.06	$57.39	$76.98
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.72 / $18.16 / $20.70	Professional	26	$13.72	$18.16	$20.70
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $26.27 / $41.96 / $56.28	Professional	TC	$26.27	$41.96	$56.28
United Facility/Professional Professional Modifier Low / Median / High Price $42.44 / $56.59 / $70.59	Professional		$42.44	$56.59	$70.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.78 / $18.03 / $23.67	Professional	26	$12.78	$18.03	$23.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.25 / $43.34 / $49.65	Professional	TC	$29.25	$43.34	$49.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.90 / $79.90 / $79.90	Professional		$67.90	$79.90	$79.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.30 / $21.50 / $21.50	Professional	26	$18.30	$21.50	$21.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $49.70 / $58.40 / $58.40	Professional	TC	$49.70	$58.40	$58.40