Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.44 / $74.44 / $74.44	Facility		$74.44	$74.44	$74.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.01 / $20.01 / $20.01	Facility	26	$20.01	$20.01	$20.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.83 / $139.19 / $209.22	Professional		$68.83	$139.19	$209.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.73 / $18.30 / $28.45	Professional	26	$16.73	$18.30	$28.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.53 / $122.46 / $134.71	Professional	TC	$50.53	$122.46	$134.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.70 / $139.58 / $174.48	Professional		$119.70	$139.58	$174.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.72 / $37.36 / $46.24	Professional	26	$31.72	$37.36	$46.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.98 / $102.59 / $128.24	Professional	TC	$87.98	$102.59	$128.24
Medica Facility/Professional Facility Modifier Low / Median / High Price $61.85 / $104.53 / $289.07	Facility		$61.85	$104.53	$289.07
Medica Facility/Professional Professional Modifier Low / Median / High Price $88.21 / $141.52 / $803.55	Professional		$88.21	$141.52	$803.55
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $37.60 / $416.07	Professional	26	$18.80	$37.60	$416.07
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $67.89 / $111.90 / $567.25	Professional	TC	$67.89	$111.90	$567.25
Midlands Facility/Professional Facility Modifier Low / Median / High Price $130.40 / $153.33 / $188.29	Facility		$130.40	$153.33	$188.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $130.40 / $153.33 / $262.64	Professional		$130.40	$153.33	$262.64
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $76.86 / $121.69 / $210.03	Professional		$76.86	$121.69	$210.03
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $21.48 / $29.69 / $34.93	Professional	26	$21.48	$29.69	$34.93
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $55.89 / $88.50 / $179.86	Professional	TC	$55.89	$88.50	$179.86
United Facility/Professional Professional Modifier Low / Median / High Price $100.86 / $141.52 / $261.39	Professional		$100.86	$141.52	$261.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.80 / $32.96 / $39.69	Professional	26	$18.80	$32.96	$39.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.04 / $101.83 / $234.99	Professional	TC	$64.04	$101.83	$234.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $132.10 / $161.60 / $161.60	Professional		$132.10	$161.60	$161.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $36.00 / $44.10 / $44.10	Professional	26	$36.00	$44.10	$44.10
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $96.10 / $117.60 / $117.60	Professional	TC	$96.10	$117.60	$117.60