Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $34.27 / $164.97 / $265.92	Facility		$34.27	$164.97	$265.92
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 $26.08 / $26.08 / $231.08	Facility	TC	$26.08	$26.08	$231.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $12.08 / $29.01 / $72.09	Professional		$12.08	$29.01	$72.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.26 / $11.51 / $29.70	Professional	26	$7.26	$11.51	$29.70
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.51 / $14.51 / $17.14	Professional	52	$14.51	$14.51	$17.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.00 / $44.08 / $135.28	Professional	TC	$21.00	$44.08	$135.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.90 / $74.47 / $93.08	Professional		$60.90	$74.47	$93.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.96 / $17.07 / $21.33	Professional	26	$13.96	$17.07	$21.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.94 / $57.40 / $71.75	Professional	TC	$46.94	$57.40	$71.75
Medica Facility/Professional Facility Modifier Low / Median / High Price $39.33 / $49.03 / $58.02	Facility		$39.33	$49.03	$58.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $35.11 / $58.57 / $206.66	Professional		$35.11	$58.57	$206.66
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 $25.57 / $42.62 / $157.81	Professional	TC	$25.57	$42.62	$157.81
Midlands Facility/Professional Facility Modifier Low / Median / High Price $56.69 / $68.20 / $108.68	Facility		$56.69	$68.20	$108.68
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $26.49 / $26.49 / $26.49	Facility	26	$26.49	$26.49	$26.49
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $68.78 / $68.78 / $68.78	Facility	TC	$68.78	$68.78	$68.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $68.20 / $81.67	Professional		$49.00	$68.20	$81.67
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $33.21 / $47.99 / $62.10	Professional		$33.21	$47.99	$62.10
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.06 / $13.05 / $15.21	Professional	26	$10.06	$13.05	$15.21
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $24.23 / $35.21 / $47.22	Professional	TC	$24.23	$35.21	$47.22
United Facility/Professional Professional Modifier Low / Median / High Price $35.11 / $46.83 / $59.42	Professional		$35.11	$46.83	$59.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.19 / $13.07 / $16.80	Professional	26	$9.19	$13.07	$16.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.78 / $42.62 / $54.11	Professional	TC	$27.78	$42.62	$54.11
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $54.80 / $64.50 / $64.50	Professional		$54.80	$64.50	$64.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $13.10 / $15.40 / $15.40	Professional	26	$13.10	$15.40	$15.40
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $41.70 / $49.00 / $49.00	Professional	TC	$41.70	$49.00	$49.00