Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $29.64 / $170.95 / $394.34	Facility		$29.64	$170.95	$394.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.48 / $7.48 / $7.48	Facility	26	$7.48	$7.48	$7.48
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.17 / $238.22 / $358.29	Facility	TC	$22.17	$238.22	$358.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.80 / $27.42 / $106.20	Professional		$17.80	$27.42	$106.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.00 / $11.32 / $26.70	Professional	26	$7.00	$11.32	$26.70
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $12.84 / $12.84 / $14.82	Professional	52	$12.84	$12.84	$14.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.30 / $31.20 / $106.20	Professional	TC	$19.30	$31.20	$106.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.92 / $65.93 / $82.42	Professional		$53.92	$65.93	$82.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.32 / $16.29 / $20.36	Professional	26	$13.32	$16.29	$20.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $49.64 / $62.06	Professional	TC	$40.60	$49.64	$62.06
Medica Facility/Professional Facility Modifier Low / Median / High Price $34.14 / $43.40 / $61.49	Facility		$34.14	$43.40	$61.49
Medica Facility/Professional Professional Modifier Low / Median / High Price $30.79 / $51.23 / $180.63	Professional		$30.79	$51.23	$180.63
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $9.22 / $14.27 / $67.70	Professional	26	$9.22	$14.27	$67.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $21.69 / $36.15 / $154.00	Professional	TC	$21.69	$36.15	$154.00
Midlands Facility/Professional Facility Modifier Low / Median / High Price $50.00 / $59.61 / $96.22	Facility		$50.00	$59.61	$96.22
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $23.85 / $23.85 / $23.85	Facility	26	$23.85	$23.85	$23.85
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $65.72 / $65.72 / $65.72	Facility	TC	$65.72	$65.72	$65.72
Midlands Facility/Professional Professional Modifier Low / Median / High Price $49.00 / $59.61 / $71.09	Professional		$49.00	$59.61	$71.09
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $31.34 / $42.47 / $54.99	Professional		$31.34	$42.47	$54.99
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $12.48 / $14.23	Professional	26	$9.44	$12.48	$14.23
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $21.46 / $30.38 / $40.75	Professional	TC	$21.46	$30.38	$40.75
United Facility/Professional Professional Modifier Low / Median / High Price $33.22 / $41.06 / $54.10	Professional		$33.22	$41.06	$54.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $13.88 / $19.93	Professional	26	$8.44	$13.88	$19.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.58 / $29.04 / $36.96	Professional	TC	$23.58	$29.04	$36.96
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $48.50 / $57.10 / $57.10	Professional		$48.50	$57.10	$57.10
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $12.60 / $14.80 / $14.80	Professional	26	$12.60	$14.80	$14.80
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $36.00 / $42.30 / $42.30	Professional	TC	$36.00	$42.30	$42.30