Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $12.02 / $12.02	Facility	26	$12.02	$12.02	$12.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $48.98 / $114.82	Professional		$42.66	$48.98	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $19.50 / $42.66	Professional	26	$12.02	$19.50	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $41.69 / $95.50	Professional	TC	$30.90	$41.69	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $112.20 / $141.25	Professional		$89.13	$112.20	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $28.84 / $35.48	Professional	26	$22.91	$28.84	$35.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $104.71	Professional	TC	$66.07	$83.18	$104.71
Medica Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $61.66 / $117.49	Professional		$44.67	$61.66	$117.49
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $20.89 / $95.50	Professional	26	$12.88	$20.89	$95.50
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $44.67 / $251.19	Professional	TC	$28.18	$44.67	$251.19
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $97.72 / $100.00	Professional		$93.33	$97.72	$100.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $26.30 / $30.90	Professional	26	$25.12	$26.30	$30.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $67.61 / $74.13	Professional	TC	$66.07	$67.61	$74.13
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Professional	26	$27.54	$27.54	$27.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	TC	$66.07	$66.07	$66.07
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $69.18 / $91.20	Professional		$51.29	$69.18	$91.20
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $20.89 / $23.99	Professional	26	$15.49	$20.89	$23.99
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $47.86 / $66.07	Professional	TC	$35.48	$47.86	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $70.79 / $102.33	Professional		$45.71	$70.79	$102.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.18 / $21.88 / $28.84	Professional	26	$13.18	$21.88	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $47.86 / $70.79	Professional	TC	$32.36	$47.86	$70.79
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $93.33 / $93.33	Professional		$79.43	$93.33	$93.33
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $25.12 / $25.12	Professional	26	$20.89	$25.12	$25.12
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $69.18 / $69.18	Professional	TC	$58.88	$69.18	$69.18