Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $263.03 / $741.31	Facility		$165.96	$263.03	$741.31
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $7.08 / $7.08	Facility	26	$7.08	$7.08	$7.08
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $104.71 / $245.47	Facility	TC	$21.88	$104.71	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.80 / $30.90 / $87.10	Professional		$13.80	$30.90	$87.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $15.85 / $29.51	Professional	26	$7.08	$15.85	$29.51
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $50.12 / $52.48 / $190.55	Professional	50	$50.12	$52.48	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $36.31 / $147.91	Professional	TC	$20.42	$36.31	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $69.18 / $87.10	Professional		$56.23	$69.18	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $17.38 / $21.88	Professional	26	$13.80	$17.38	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $52.48 / $66.07	Professional	TC	$41.69	$52.48	$66.07
Medica Facility/Professional Facility Modifier Low / Median / High Price $32.36 / $44.67 / $138.04	Facility		$32.36	$44.67	$138.04
Medica Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $38.90 / $72.44	Professional		$28.18	$38.90	$72.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $15.14 / $23.44	Professional	26	$9.33	$15.14	$23.44
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $27.54 / $162.18	Professional	TC	$17.38	$27.54	$162.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $61.66 / $63.10	Professional		$57.54	$61.66	$63.10
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $16.22 / $19.50	Professional	26	$15.49	$16.22	$19.50
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $42.66 / $46.77	Professional	TC	$41.69	$42.66	$46.77
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 $17.38 / $17.38 / $17.38	Professional	26	$17.38	$17.38	$17.38
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $41.69 / $41.69	Professional	TC	$41.69	$41.69	$41.69
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $42.66 / $57.54	Professional		$32.36	$42.66	$57.54
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $13.18 / $14.79	Professional	26	$9.55	$13.18	$14.79
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $30.20 / $41.69	Professional	TC	$22.39	$30.20	$41.69
United Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $43.65 / $64.57	Professional		$28.84	$43.65	$64.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $13.80 / $18.20	Professional	26	$8.13	$13.80	$18.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $29.51 / $43.65	Professional	TC	$20.89	$29.51	$43.65
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $58.88 / $58.88	Professional		$50.12	$58.88	$58.88
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $15.49 / $15.49	Professional	26	$13.18	$15.49	$15.49
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $43.65 / $43.65	Professional	TC	$37.15	$43.65	$43.65