Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.75 / $12.75 / $12.75	Facility	26	$12.75	$12.75	$12.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.88 / $55.93 / $152.19	Professional		$46.88	$55.93	$152.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $15.96 / $52.51	Professional	26	$12.09	$15.96	$52.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $49.71 / $109.98	Professional	TC	$38.76	$49.71	$109.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.14 / $121.78 / $152.22	Professional		$99.14	$121.78	$152.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.47 / $28.70 / $35.88	Professional	26	$23.47	$28.70	$35.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.17 / $93.08 / $116.36	Professional	TC	$72.17	$93.08	$116.36
Medica Facility/Professional Professional Modifier Low / Median / High Price $56.10 / $89.97 / $330.09	Professional		$56.10	$89.97	$330.09
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.76 / $24.29 / $120.54	Professional	26	$15.76	$24.29	$120.54
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $39.79 / $65.68 / $292.00	Professional	TC	$39.79	$65.68	$292.00
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Midlands Facility/Professional Professional Modifier Low / Median / High Price $92.00 / $111.01 / $129.29	Professional		$92.00	$111.01	$129.29
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $59.20 / $80.81 / $100.92	Professional		$59.20	$80.81	$100.92
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $16.96 / $21.56 / $26.69	Professional	26	$16.96	$21.56	$26.69
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $39.65 / $56.91 / $76.33	Professional	TC	$39.65	$56.91	$76.33
United Facility/Professional Professional Modifier Low / Median / High Price $58.36 / $78.20 / $97.76	Professional		$58.36	$78.20	$97.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $20.57 / $31.44	Professional	26	$14.79	$20.57	$31.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.38 / $51.60 / $66.31	Professional	TC	$42.38	$51.60	$66.31
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $89.10 / $104.80 / $104.80	Professional		$89.10	$104.80	$104.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $21.70 / $25.50 / $25.50	Professional	26	$21.70	$25.50	$25.50
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $79.30 / $79.30	Professional	TC	$67.40	$79.30	$79.30