Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $12.88 / $12.88	Facility	26	$12.88	$12.88	$12.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $79.43 / $173.78	Professional		$50.12	$79.43	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $22.39 / $48.98	Professional	26	$12.30	$22.39	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $61.66 / $165.96	Professional	TC	$37.15	$61.66	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $128.82 / $162.18	Professional		$102.33	$128.82	$162.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $30.20 / $38.02	Professional	26	$23.99	$30.20	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $100.00 / $123.03	Professional	TC	$79.43	$100.00	$123.03
Medica Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $67.61 / $128.82	Professional		$45.71	$67.61	$128.82
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $25.12 / $53.70	Professional	26	$15.14	$25.12	$53.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $46.77 / $257.04	Professional	TC	$31.62	$46.77	$257.04
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $112.20 / $114.82	Professional		$104.71	$112.20	$114.82
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $27.54 / $36.31	Professional	26	$25.70	$27.54	$36.31
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $79.43 / $87.10	Professional	TC	$75.86	$79.43	$87.10
Midlands Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $104.71 / $104.71	Professional		$104.71	$104.71	$104.71
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $28.18 / $28.18	Professional	26	$28.18	$28.18	$28.18
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $75.86 / $75.86	Professional	TC	$75.86	$75.86	$75.86
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $77.62 / $104.71	Professional		$58.88	$77.62	$104.71
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.91 / $26.30	Professional	26	$16.98	$22.91	$26.30
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $56.23 / $79.43	Professional	TC	$40.74	$56.23	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $77.62 / $112.20	Professional		$54.95	$77.62	$112.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $25.12 / $33.88	Professional	26	$15.14	$25.12	$33.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $53.70 / $79.43	Professional	TC	$35.48	$53.70	$79.43
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $109.65 / $109.65	Professional		$93.33	$109.65	$109.65
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $26.30 / $26.30	Professional	26	$22.39	$26.30	$26.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $83.18 / $83.18	Professional	TC	$70.79	$83.18	$83.18