Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $323.59 / $588.84	Facility		$102.33	$323.59	$588.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.91 / $257.04 / $257.04	Facility	26	$8.91	$257.04	$257.04
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $26.92 / $281.84 / $380.19	Facility	TC	$26.92	$281.84	$380.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $32.36 / $141.25	Professional		$8.71	$32.36	$141.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.00 / $40.74	Professional	26	$8.51	$10.00	$40.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $33.11 / $102.33 / $223.87	Professional	50	$33.11	$102.33	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $48.98 / $229.09	Professional	TC	$24.55	$48.98	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $83.18 / $102.33	Professional		$66.07	$83.18	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $20.42 / $25.70	Professional	26	$16.60	$20.42	$25.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $61.66 / $77.62	Professional	TC	$48.98	$61.66	$77.62
Medica Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $56.23 / $363.08	Facility		$38.02	$56.23	$363.08
Medica Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $43.65 / $100.00	Professional		$28.84	$43.65	$100.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $17.38 / $23.44	Professional	26	$11.48	$17.38	$23.44
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.90 / $177.83	Professional	TC	$20.42	$30.90	$177.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $67.61 / $74.13	Professional		$66.07	$67.61	$74.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $19.05 / $21.88	Professional	26	$18.20	$19.05	$21.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $50.12 / $54.95	Professional	TC	$44.67	$50.12	$54.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $67.61	Professional		$67.61	$67.61	$67.61
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $19.50 / $19.50	Professional	26	$19.50	$19.50	$19.50
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $47.86 / $47.86	Professional	TC	$47.86	$47.86	$47.86
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $48.98 / $67.61	Professional		$36.31	$48.98	$67.61
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $15.49 / $17.38	Professional	26	$11.22	$15.49	$17.38
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.11 / $50.12	Professional	TC	$25.12	$33.11	$50.12
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $48.98 / $72.44	Professional		$32.36	$48.98	$72.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $15.85 / $20.42	Professional	26	$9.55	$15.85	$20.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $50.12	Professional	TC	$22.91	$33.88	$50.12
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $69.18 / $69.18	Professional		$58.88	$69.18	$69.18
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $18.20 / $18.20	Professional	26	$15.49	$18.20	$18.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $51.29 / $51.29	Professional	TC	$43.65	$51.29	$51.29