Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $489.78 / $794.33	Facility		$275.42	$489.78	$794.33
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $33.11 / $33.11	Facility	26	$33.11	$33.11	$33.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $89.13 / $208.93	Professional		$36.31	$89.13	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $54.95 / $95.50	Professional	26	$30.90	$54.95	$95.50
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $75.86 / $173.78 / $676.08	Professional	50	$75.86	$173.78	$676.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $81.28 / $186.21	Professional	TC	$48.98	$81.28	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $204.17 / $251.19	Professional		$162.18	$204.17	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $75.86 / $93.33	Professional	26	$60.26	$75.86	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $125.89 / $158.49	Professional	TC	$102.33	$125.89	$158.49
Medica Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $138.04 / $446.68	Facility		$107.15	$138.04	$446.68
Medica Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $134.90 / $549.54	Professional		$81.28	$134.90	$549.54
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $63.10 / $204.17	Professional	26	$38.90	$63.10	$204.17
Medica Facility/Professional Professional Modifier 50 Low / Median / High Price $331.13 / $331.13 / $331.13	Professional	50	$331.13	$331.13	$331.13
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $100.00 / $338.84	Professional	TC	$54.95	$100.00	$338.84
Midlands Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $194.98 / $194.98	Professional		$165.96	$194.98	$194.98
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $79.43 / $79.43	Professional	26	$64.57	$79.43	$79.43
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $117.49 / $117.49	Professional	TC	$102.33	$117.49	$117.49
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $165.96	Professional		$104.71	$144.54	$165.96
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $56.23 / $63.10	Professional	26	$39.81	$56.23	$63.10
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $89.13 / $102.33	Professional	TC	$64.57	$89.13	$102.33
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $131.83 / $194.98	Professional		$91.20	$131.83	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $51.29 / $72.44	Professional	26	$34.67	$51.29	$72.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $79.43 / $120.23	Professional	TC	$56.23	$79.43	$120.23
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $177.83 / $177.83	Professional		$151.36	$177.83	$177.83
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $67.61	Professional	26	$57.54	$67.61	$67.61
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $109.65 / $109.65	Professional	TC	$93.33	$109.65	$109.65