Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $42.66 / $309.03 / $1,202.26	Facility		$42.66	$309.03	$1,202.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $10.00	Facility	26	$10.00	$10.00	$10.00
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $32.36 / $46.77	Facility	TC	$32.36	$32.36	$46.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $46.77 / $95.50	Professional		$38.02	$46.77	$95.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.13 / $33.11	Professional	26	$10.00	$14.13	$33.11
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $147.91 / $147.91 / $147.91	Professional	50	$147.91	$147.91	$147.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $32.36 / $60.26	Professional	TC	$27.54	$32.36	$60.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $97.72 / $123.03	Professional		$79.43	$97.72	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.55 / $30.90	Professional	26	$19.50	$24.55	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $74.13 / $93.33	Professional	TC	$58.88	$74.13	$93.33
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.65 / $60.26 / $74.13	Facility		$43.65	$60.26	$74.13
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $58.88 / $100.00	Professional		$39.81	$58.88	$100.00
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $17.78 / $41.69	Professional	26	$11.75	$17.78	$41.69
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $41.69 / $79.43	Professional	TC	$28.18	$41.69	$79.43
Midlands Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $85.11 / $89.13	Professional		$81.28	$85.11	$89.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $22.91 / $26.30	Professional	26	$21.38	$22.91	$26.30
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $66.07	Professional	TC	$58.88	$58.88	$66.07
Midlands Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $81.28 / $81.28	Professional		$81.28	$81.28	$81.28
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $23.44 / $23.44	Professional	26	$23.44	$23.44	$23.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $58.88 / $58.88	Professional	TC	$58.88	$58.88	$58.88
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $67.61 / $79.43	Professional		$46.77	$67.61	$79.43
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $18.20 / $20.89	Professional	26	$12.59	$18.20	$20.89
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $50.12 / $58.88	Professional	TC	$33.11	$50.12	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $63.10 / $93.33	Professional		$44.67	$63.10	$93.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $18.62 / $25.12	Professional	26	$12.88	$18.62	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $44.67 / $69.18	Professional	TC	$30.90	$44.67	$69.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $83.18 / $83.18	Professional		$70.79	$83.18	$83.18
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $21.38 / $21.38	Professional	26	$18.20	$21.38	$21.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $61.66 / $61.66	Professional	TC	$52.48	$61.66	$61.66