Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $105.45 / $424.94 / $560.46	Facility		$105.45	$424.94	$560.46
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.24 / $9.24 / $9.24	Facility	26	$9.24	$9.24	$9.24
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $33.54 / $132.54 / $245.74	Facility	TC	$33.54	$132.54	$245.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.77 / $36.89 / $96.04	Professional		$8.77	$36.89	$96.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.52 / $14.53 / $47.94	Professional	26	$8.52	$14.53	$47.94
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.00 / $34.00 / $34.00	Professional	50	$34.00	$34.00	$34.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.44 / $18.44 / $21.40	Professional	52	$18.44	$18.44	$21.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.10 / $62.98 / $323.07	Professional	TC	$28.10	$62.98	$323.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.39 / $94.64 / $118.29	Professional		$77.39	$94.64	$118.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.48 / $20.17 / $25.21	Professional	26	$16.48	$20.17	$25.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.44 / $74.47 / $93.08	Professional	TC	$60.44	$74.47	$93.08
Medica Facility/Professional Facility Modifier Low / Median / High Price $46.56 / $62.34 / $322.92	Facility		$46.56	$62.34	$322.92
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.39 / $71.62 / $263.06	Professional		$39.39	$71.62	$263.06
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $11.36 / $17.61 / $79.26	Professional	26	$11.36	$17.61	$79.26
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $31.61 / $53.49 / $205.55	Professional	TC	$31.61	$53.49	$205.55
Midlands Facility/Professional Facility Modifier Low / Median / High Price $68.25 / $82.43 / $138.11	Facility		$68.25	$82.43	$138.11
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $31.99 / $31.99 / $31.99	Facility	26	$31.99	$31.99	$31.99
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $90.34 / $90.34 / $90.34	Facility	TC	$90.34	$90.34	$90.34
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.00 / $82.43 / $103.34	Professional		$57.00	$82.43	$103.34
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $41.34 / $58.84 / $78.92	Professional		$41.34	$58.84	$78.92
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.63 / $15.32 / $17.47	Professional	26	$11.63	$15.32	$17.47
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $31.87 / $45.82 / $61.46	Professional	TC	$31.87	$45.82	$61.46
United Facility/Professional Professional Modifier Low / Median / High Price $43.81 / $57.95 / $72.59	Professional		$43.81	$57.95	$72.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.79 / $17.14 / $20.43	Professional	26	$10.79	$17.14	$20.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.61 / $43.20 / $55.31	Professional	TC	$31.61	$43.20	$55.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $69.70 / $81.90 / $81.90	Professional		$69.70	$81.90	$81.90
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $15.40 / $18.10 / $18.10	Professional	26	$15.40	$18.10	$18.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $54.20 / $63.80 / $63.80	Professional	TC	$54.20	$63.80	$63.80