Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $208.93 / $398.11	Facility		$91.20	$208.93	$398.11
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.08 / $7.08 / $7.08	Facility	26	$7.08	$7.08	$7.08
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $21.88 / $239.88 / $354.81	Facility	TC	$21.88	$239.88	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $36.31 / $112.20	Professional		$17.78	$36.31	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.13 / $46.77	Professional	26	$7.08	$14.13	$46.77
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $24.55 / $52.48 / $190.55	Professional	50	$24.55	$52.48	$190.55
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.05 / $26.30 / $50.12	Professional	52	$19.05	$26.30	$50.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $36.31 / $114.82	Professional	TC	$19.50	$36.31	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $67.61 / $85.11	Professional		$53.70	$67.61	$85.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $16.60 / $20.89	Professional	26	$13.18	$16.60	$20.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $51.29 / $63.10	Professional	TC	$40.74	$51.29	$63.10
Medica Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $41.69 / $75.86	Facility		$30.90	$41.69	$75.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $38.90 / $72.44	Professional		$26.92	$38.90	$72.44
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.30 / $21.38	Professional	26	$7.94	$12.30	$21.38
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $28.84 / $154.88	Professional	TC	$18.20	$28.84	$154.88
Midlands Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $60.26 / $60.26	Professional		$56.23	$60.26	$60.26
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $15.49 / $17.78	Professional	26	$14.79	$15.49	$17.78
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $41.69 / $44.67	Professional	TC	$40.74	$41.69	$44.67
Midlands Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $56.23 / $56.23	Professional		$56.23	$56.23	$56.23
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $16.22 / $16.22	Professional	26	$16.22	$16.22	$16.22
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $40.74 / $40.74	Professional	TC	$40.74	$40.74	$40.74
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $42.66 / $54.95	Professional		$31.62	$42.66	$54.95
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $12.59 / $14.13	Professional	26	$9.12	$12.59	$14.13
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $30.90 / $40.74	Professional	TC	$21.38	$30.90	$40.74
United Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $43.65 / $61.66	Professional		$28.18	$43.65	$61.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.18 / $16.60	Professional	26	$7.94	$13.18	$16.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.90 / $45.71	Professional	TC	$20.42	$30.90	$45.71
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $57.54 / $57.54	Professional		$48.98	$57.54	$57.54
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $14.79 / $14.79	Professional	26	$12.59	$14.79	$14.79
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $42.66 / $42.66	Professional	TC	$36.31	$42.66	$42.66