Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $111.71 / $292.50 / $540.12	Facility		$111.71	$292.50	$540.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.53 / $8.53 / $8.53	Facility	26	$8.53	$8.53	$8.53
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $30.35 / $274.42 / $404.81	Facility	TC	$30.35	$274.42	$404.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.07 / $32.64 / $149.52	Professional		$8.07	$32.64	$149.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.78 / $8.40 / $42.59	Professional	26	$7.78	$8.40	$42.59
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $39.82 / $39.82 / $39.82	Professional	50	$39.82	$39.82	$39.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.48 / $16.48 / $19.44	Professional	52	$16.48	$16.48	$19.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.24 / $48.42 / $210.60	Professional	TC	$25.24	$48.42	$210.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.15 / $84.55 / $105.69	Professional		$69.15	$84.55	$105.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.23 / $18.62 / $23.27	Professional	26	$15.23	$18.62	$23.27
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.23 / $65.93 / $82.42	Professional	TC	$53.23	$65.93	$82.42
Medica Facility/Professional Facility Modifier Low / Median / High Price $43.50 / $55.69 / $258.89	Facility		$43.50	$55.69	$258.89
Medica Facility/Professional Professional Modifier Low / Median / High Price $34.86 / $63.02 / $237.03	Professional		$34.86	$63.02	$237.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.55 / $16.97 / $24.59	Professional	26	$10.55	$16.97	$24.59
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $27.30 / $47.02 / $183.85	Professional	TC	$27.30	$47.02	$183.85
Midlands Facility/Professional Facility Modifier Low / Median / High Price $60.11 / $73.77 / $123.41	Facility		$60.11	$73.77	$123.41
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $27.69 / $27.69 / $27.69	Facility	26	$27.69	$27.69	$27.69
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $82.22 / $82.22 / $82.22	Facility	TC	$82.22	$82.22	$82.22
Midlands Facility/Professional Professional Modifier Low / Median / High Price $53.00 / $73.77 / $93.45	Professional		$53.00	$73.77	$93.45
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $37.75 / $52.57 / $70.51	Professional		$37.75	$52.57	$70.51
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $10.76 / $14.19 / $16.17	Professional	26	$10.76	$14.19	$16.17
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $27.56 / $40.51 / $54.34	Professional	TC	$27.56	$40.51	$54.34
United Facility/Professional Professional Modifier Low / Median / High Price $38.70 / $53.57 / $64.58	Professional		$38.70	$53.57	$64.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.98 / $14.02 / $17.52	Professional	26	$9.98	$14.02	$17.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.46 / $45.50 / $51.10	Professional	TC	$28.46	$45.50	$51.10
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $62.20 / $73.20 / $73.20	Professional		$62.20	$73.20	$73.20
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $14.30 / $16.80 / $16.80	Professional	26	$14.30	$16.80	$16.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $48.00 / $56.40 / $56.40	Professional	TC	$48.00	$56.40	$56.40