Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.98 / $351.08 / $666.70	Facility		$75.98	$351.08	$666.70
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 $27.86 / $231.08 / $245.74	Facility	TC	$27.86	$231.08	$245.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $7.78 / $30.60 / $76.50	Professional		$7.78	$30.60	$76.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $13.44 / $54.00	Professional	26	$7.61	$13.44	$54.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $15.42 / $15.42 / $18.02	Professional	52	$15.42	$15.42	$18.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.05 / $39.79 / $76.50	Professional	TC	$22.05	$39.79	$76.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.70 / $79.12 / $98.90	Professional		$64.70	$79.12	$98.90
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 $50.12 / $61.28 / $76.59	Professional	TC	$50.12	$61.28	$76.59
Medica Facility/Professional Facility Modifier Low / Median / High Price $40.75 / $52.10 / $268.48	Facility		$40.75	$52.10	$268.48
Medica Facility/Professional Facility Modifier TC Low / Median / High Price $268.48 / $272.06 / $279.22	Facility	TC	$268.48	$272.06	$279.22
Medica Facility/Professional Professional Modifier Low / Median / High Price $36.95 / $61.58 / $219.71	Professional		$36.95	$61.58	$219.71
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.08 / $15.60 / $67.70	Professional	26	$10.08	$15.60	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $26.87 / $45.07 / $168.70	Professional	TC	$26.87	$45.07	$168.70
Midlands Facility/Professional Facility Modifier Low / Median / High Price $58.71 / $71.36 / $115.47	Facility		$58.71	$71.36	$115.47
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $31.12 / $31.12 / $31.12	Facility	26	$31.12	$31.12	$31.12
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $71.51 / $71.51 / $71.51	Facility	TC	$71.51	$71.51	$71.51
Midlands Facility/Professional Professional Modifier Low / Median / High Price $52.00 / $71.36 / $86.75	Professional		$52.00	$71.36	$86.75
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $35.18 / $49.70 / $65.98	Professional		$35.18	$49.70	$65.98
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.33 / $13.62 / $15.67	Professional	26	$10.33	$13.62	$15.67
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $24.68 / $37.61 / $50.46	Professional	TC	$24.68	$37.61	$50.46
United Facility/Professional Professional Modifier Low / Median / High Price $40.15 / $60.25 / $64.66	Professional		$40.15	$60.25	$64.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.59 / $14.28 / $18.10	Professional	26	$9.59	$14.28	$18.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.04 / $44.78 / $48.87	Professional	TC	$30.04	$44.78	$48.87
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $58.20 / $68.50 / $68.50	Professional		$58.20	$68.50	$68.50
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 $44.50 / $52.40 / $52.40	Professional	TC	$44.50	$52.40	$52.40