Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $309.03 / $537.03	Facility		$138.04	$309.03	$537.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.94 / $7.94 / $7.94	Facility	26	$7.94	$7.94	$7.94
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.20 / $245.47 / $407.38	Facility	TC	$30.20	$245.47	$407.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.13 / $36.31 / $107.15	Professional		$8.13	$36.31	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.96 / $42.66	Professional	26	$7.94	$10.96	$42.66
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.81 / $95.50 / $223.87	Professional	50	$39.81	$95.50	$223.87
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.26 / $60.26 / $60.26	Professional	52	$60.26	$60.26	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $43.65 / $190.55	Professional	TC	$25.70	$43.65	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $87.10 / $107.15	Professional		$69.18	$87.10	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.05 / $23.99	Professional	26	$15.14	$19.05	$23.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $67.61 / $85.11	Professional	TC	$53.70	$67.61	$85.11
Medica Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $56.23 / $269.15	Facility		$39.81	$56.23	$269.15
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $46.77 / $107.15	Professional		$30.20	$46.77	$107.15
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $16.22 / $21.88	Professional	26	$10.23	$16.22	$21.88
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $36.31 / $181.97	Professional	TC	$22.91	$36.31	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $74.13 / $77.62	Professional		$70.79	$74.13	$77.62
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $17.78 / $20.42	Professional	26	$16.98	$17.78	$20.42
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $54.95 / $60.26	Professional	TC	$53.70	$54.95	$60.26
Midlands Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $70.79 / $70.79	Professional		$70.79	$70.79	$70.79
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $18.20 / $18.20	Professional	26	$18.20	$18.20	$18.20
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $53.70	Professional	TC	$53.70	$53.70	$53.70
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $52.48 / $70.79	Professional		$38.02	$52.48	$70.79
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.13 / $16.22	Professional	26	$10.47	$14.13	$16.22
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $54.95	Professional	TC	$28.84	$38.90	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $53.70 / $79.43	Professional		$34.67	$53.70	$79.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $14.79 / $19.05	Professional	26	$8.91	$14.79	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.90 / $56.23	Professional	TC	$25.12	$38.90	$56.23
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $72.44 / $72.44	Professional		$61.66	$72.44	$72.44
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $16.98 / $16.98	Professional	26	$14.45	$16.98	$16.98
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $56.23 / $56.23	Professional	TC	$47.86	$56.23	$56.23