Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $32.84 / $129.90 / $338.55	Facility		$32.84	$129.90	$338.55
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.19 / $8.19 / $8.19	Facility	26	$8.19	$8.19	$8.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $24.66 / $24.66 / $393.36	Facility	TC	$24.66	$24.66	$393.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $7.83 / $29.70 / $64.97	Professional		$7.83	$29.70	$64.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.48 / $9.86 / $34.71	Professional	26	$7.48	$9.86	$34.71
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $51.02 / $51.02 / $51.02	Professional	50	$51.02	$51.02	$51.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.20 / $16.42 / $24.16	Professional	52	$14.20	$16.42	$24.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.28 / $40.29 / $113.60	Professional	TC	$20.28	$40.29	$113.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $59.63 / $72.92 / $91.14	Professional		$59.63	$72.92	$91.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.59 / $17.84 / $22.30	Professional	26	$14.59	$17.84	$22.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.46 / $55.07 / $68.84	Professional	TC	$44.46	$55.07	$68.84
Medica Facility/Professional Facility Modifier Low / Median / High Price $34.51 / $48.00 / $55.50	Facility		$34.51	$48.00	$55.50
Medica Facility/Professional Professional Modifier Low / Median / High Price $31.34 / $54.40 / $200.17	Professional		$31.34	$54.40	$200.17
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.08 / $15.60 / $61.09	Professional	26	$10.08	$15.60	$61.09
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.26 / $37.21 / $154.00	Professional	TC	$21.26	$37.21	$154.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $64.28 / $106.44	Facility		$50.00	$64.28	$106.44
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.51 / $26.51 / $26.51	Facility	26	$26.51	$26.51	$26.51
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $64.95 / $64.95 / $64.95	Facility	TC	$64.95	$64.95	$64.95
Midlands Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $64.28 / $78.06	Professional		$49.00	$64.28	$78.06
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $31.85 / $45.34 / $60.81	Professional		$31.85	$45.34	$60.81
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.06 / $13.62 / $15.53	Professional	26	$10.06	$13.62	$15.53
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.53 / $33.76 / $45.28	Professional	TC	$21.53	$33.76	$45.28
United Facility/Professional Professional Modifier Low / Median / High Price $33.83 / $44.72 / $55.91	Professional		$33.83	$44.72	$55.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.59 / $13.44 / $16.80	Professional	26	$9.59	$13.44	$16.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.69 / $31.65 / $40.31	Professional	TC	$20.69	$31.65	$40.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $63.10 / $63.10	Professional		$53.70	$63.10	$63.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.70 / $16.10 / $16.10	Professional	26	$13.70	$16.10	$16.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $40.00 / $47.00 / $47.00	Professional	TC	$40.00	$47.00	$47.00