Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $302.00 / $436.52	Facility		$134.90	$302.00	$436.52
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $7.94 / $7.94	Facility	26	$7.94	$7.94	$7.94
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $19.95 / $316.23 / $398.11	Facility	TC	$19.95	$316.23	$398.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $38.02 / $93.33	Professional		$23.99	$38.02	$93.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $8.71 / $28.18	Professional	26	$7.94	$8.71	$28.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $35.48 / $213.80	Professional	TC	$18.62	$35.48	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $66.07 / $83.18	Professional		$52.48	$66.07	$83.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.05 / $23.99	Professional	26	$15.14	$19.05	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $46.77 / $58.88	Professional	TC	$37.15	$46.77	$58.88
Medica Facility/Professional Facility Modifier Low / Median / High Price $30.20 / $42.66 / $87.10	Facility		$30.20	$42.66	$87.10
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $199.53 / $199.53 / $199.53	Facility	TC	$199.53	$199.53	$199.53
Medica Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $41.69 / $91.20	Professional		$26.92	$41.69	$91.20
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $15.85 / $21.88	Professional	26	$9.55	$15.85	$21.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $32.36 / $162.18	Professional	TC	$19.95	$32.36	$162.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $60.26 / $72.44	Professional		$54.95	$60.26	$72.44
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $17.78 / $20.42	Professional	26	$16.98	$17.78	$20.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $41.69 / $52.48	Professional	TC	$38.02	$41.69	$52.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $58.88	Professional		$58.88	$58.88	$58.88
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.20 / $18.20	Professional	26	$18.20	$18.20	$18.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	TC	$39.81	$39.81	$39.81
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $45.71 / $54.95	Professional		$32.36	$45.71	$54.95
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.13 / $16.22	Professional	26	$10.47	$14.13	$16.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $31.62 / $38.90	Professional	TC	$20.89	$31.62	$38.90
United Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $51.29 / $69.18	Professional		$30.20	$51.29	$69.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.79 / $19.05	Professional	26	$8.91	$14.79	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $35.48 / $50.12	Professional	TC	$20.89	$35.48	$50.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $56.23 / $56.23	Professional		$47.86	$56.23	$56.23
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $16.98 / $16.98	Professional	26	$14.45	$16.98	$16.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $39.81 / $39.81	Professional	TC	$33.88	$39.81	$39.81