Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.57 / $409.03 / $607.42	Facility		$95.57	$409.03	$607.42
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 $31.06 / $395.57 / $520.70	Facility	TC	$31.06	$395.57	$520.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.97 / $42.05 / $99.68	Professional		$35.97	$42.05	$99.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.15 / $10.99 / $36.90	Professional	26	$10.15	$10.99	$36.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.94 / $44.73 / $270.00	Professional	TC	$27.94	$44.73	$270.00
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 $45.65 / $60.81 / $131.13	Facility		$45.65	$60.81	$131.13
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $332.01 / $332.01 / $332.01	Facility	TC	$332.01	$332.01	$332.01
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.12 / $70.20 / $256.38	Professional		$42.12	$70.20	$256.38
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.52 / $20.95 / $82.56	Professional	26	$13.52	$20.95	$82.56
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.60 / $48.31 / $211.00	Professional	TC	$28.60	$48.31	$211.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $70.00 / $81.18 / $134.72	Facility		$70.00	$81.18	$134.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $38.45 / $38.45 / $38.45	Facility	26	$38.45	$38.45	$38.45
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $84.10 / $84.10 / $84.10	Facility	TC	$84.10	$84.10	$84.10
Midlands Facility/Professional Professional Modifier Low / Median / High Price $67.00 / $81.18 / $100.00	Professional		$67.00	$81.18	$100.00
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $42.64 / $57.81 / $76.98	Professional		$42.64	$57.81	$76.98
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.28 / $18.16 / $20.70	Professional	26	$13.28	$18.16	$20.70
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $29.82 / $41.96 / $56.28	Professional	TC	$29.82	$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 / $22.54	Professional	26	$12.78	$18.03	$22.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.04 / $39.01 / $49.65	Professional	TC	$31.04	$39.01	$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