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 $45.71 / $61.66 / $151.36	Professional		$45.71	$61.66	$151.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $15.85 / $48.98	Professional	26	$12.02	$15.85	$48.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $58.88 / $134.90	Professional	TC	$36.31	$58.88	$134.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $125.89 / $154.88	Professional		$100.00	$125.89	$154.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $29.51 / $36.31	Professional	26	$23.44	$29.51	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $95.50 / $120.23	Professional	TC	$75.86	$95.50	$120.23
Medica Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $72.44 / $138.04	Professional		$50.12	$72.44	$138.04
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $23.99 / $53.70	Professional	26	$15.14	$23.99	$53.70
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $51.29 / $295.12	Professional	TC	$33.11	$51.29	$295.12
Midlands Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $112.20 / $112.20	Professional		$102.33	$112.20	$112.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $26.92 / $36.31	Professional	26	$25.12	$26.92	$36.31
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $77.62 / $83.18	Professional	TC	$75.86	$77.62	$83.18
Midlands Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Professional		$100.00	$100.00	$100.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $26.92 / $26.92	Professional	26	$26.92	$26.92	$26.92
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $72.44 / $72.44	Professional	TC	$72.44	$72.44	$72.44
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $81.28 / $100.00	Professional		$58.88	$81.28	$100.00
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $22.91 / $26.92	Professional	26	$16.22	$22.91	$26.92
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $57.54 / $75.86	Professional	TC	$39.81	$57.54	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $83.18 / $114.82	Professional		$53.70	$83.18	$114.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $23.44 / $33.88	Professional	26	$14.79	$23.44	$33.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $56.23 / $83.18	Professional	TC	$38.90	$56.23	$83.18
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $104.71 / $104.71	Professional		$89.13	$104.71	$104.71
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $25.70 / $25.70	Professional	26	$21.88	$25.70	$25.70
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $79.43 / $79.43	Professional	TC	$67.61	$79.43	$79.43