Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $478.63 / $691.83	Facility		$112.20	$478.63	$691.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $15.14 / $15.14	Facility	26	$15.14	$15.14	$15.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $112.20 / $281.84	Professional		$93.33	$112.20	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $22.91 / $57.54	Professional	26	$14.13	$22.91	$57.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $91.20 / $158.49	Professional	TC	$79.43	$91.20	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $245.47 / $309.03	Professional		$194.98	$245.47	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $35.48 / $44.67	Professional	26	$28.84	$35.48	$44.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $208.93 / $263.03	Professional	TC	$165.96	$208.93	$263.03
Medica Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $147.91 / $186.21	Facility		$107.15	$147.91	$186.21
Medica Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $123.03 / $234.42	Professional		$91.20	$123.03	$234.42
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $25.70 / $151.36	Professional	26	$16.60	$25.70	$151.36
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $104.71 / $588.84	Professional	TC	$69.18	$104.71	$588.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $204.17 / $218.78	Professional		$199.53	$204.17	$218.78
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $33.11 / $38.02	Professional	26	$31.62	$33.11	$38.02
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $169.82 / $181.97	Professional	TC	$162.18	$169.82	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Professional		$199.53	$199.53	$199.53
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $33.88	Professional	26	$33.88	$33.88	$33.88
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $165.96 / $165.96	Professional	TC	$165.96	$165.96	$165.96
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $194.98	Professional		$107.15	$138.04	$194.98
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $25.70 / $29.51	Professional	26	$18.62	$25.70	$29.51
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $120.23 / $165.96	Professional	TC	$89.13	$120.23	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $141.25 / $204.17	Professional		$93.33	$141.25	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $28.18 / $35.48	Professional	26	$16.98	$28.18	$35.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $112.20 / $169.82	Professional	TC	$75.86	$112.20	$169.82
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $204.17 / $204.17	Professional		$173.78	$204.17	$204.17
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $30.90 / $30.90	Professional	26	$26.30	$30.90	$30.90
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $173.78 / $173.78	Professional	TC	$147.91	$173.78	$173.78