Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $363.08 / $575.44	Facility		$134.90	$363.08	$575.44
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 $25.12 / $223.87 / $331.13	Facility	TC	$25.12	$223.87	$331.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.32 / $33.88 / $107.15	Professional		$8.32	$33.88	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.18 / $40.74	Professional	26	$7.94	$13.18	$40.74
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $52.48 / $56.23 / $239.88	Professional	50	$52.48	$56.23	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $43.65 / $154.88	Professional	TC	$22.39	$43.65	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $77.62 / $97.72	Professional		$61.66	$77.62	$97.72
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 $46.77 / $58.88 / $74.13	Professional	TC	$46.77	$58.88	$74.13
Medica Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $47.86 / $81.28	Facility		$34.67	$47.86	$81.28
Medica Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $46.77 / $95.50	Professional		$31.62	$46.77	$95.50
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $15.85 / $24.55	Professional	26	$9.55	$15.85	$24.55
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $32.36 / $177.83	Professional	TC	$22.39	$32.36	$177.83
Midlands Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $66.07 / $69.18	Professional		$64.57	$66.07	$69.18
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 $45.71 / $46.77 / $52.48	Professional	TC	$45.71	$46.77	$52.48
Midlands Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $63.10 / $63.10	Professional		$63.10	$63.10	$63.10
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 $45.71 / $45.71 / $45.71	Professional	TC	$45.71	$45.71	$45.71
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $52.48 / $63.10	Professional		$36.31	$52.48	$63.10
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.80 / $16.22	Professional	26	$10.47	$13.80	$16.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $36.31 / $46.77	Professional	TC	$25.70	$36.31	$46.77
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $52.48 / $72.44	Professional		$34.67	$52.48	$72.44
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 $24.55 / $38.02 / $53.70	Professional	TC	$24.55	$38.02	$53.70
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $66.07 / $66.07	Professional		$56.23	$66.07	$66.07
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 $41.69 / $48.98 / $48.98	Professional	TC	$41.69	$48.98	$48.98