Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $10.00 / $10.00	Facility	26	$10.00	$10.00	$10.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $45.71 / $117.49	Professional		$34.67	$45.71	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $16.22 / $33.11	Professional	26	$9.55	$16.22	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $34.67 / $85.11	Professional	TC	$25.70	$34.67	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $93.33 / $117.49	Professional		$74.13	$93.33	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $24.55 / $30.90	Professional	26	$19.50	$24.55	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $69.18 / $87.10	Professional	TC	$54.95	$69.18	$87.10
Medica Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $52.48 / $93.33	Professional		$36.31	$52.48	$93.33
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $10.23 / $18.20 / $33.11	Professional	26	$10.23	$18.20	$33.11
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $37.15 / $181.97	Professional	TC	$23.44	$37.15	$181.97
Midlands Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $77.62 / $83.18	Professional		$75.86	$77.62	$83.18
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $21.88 / $22.91	Professional	26	$21.88	$21.88	$22.91
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $54.95 / $61.66	Professional	TC	$54.95	$54.95	$61.66
Midlands Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $23.99 / $23.99	Professional	26	$23.99	$23.99	$23.99
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $53.70 / $53.70	Professional	TC	$53.70	$53.70	$53.70
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $53.70 / $75.86	Professional		$39.81	$53.70	$75.86
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $15.85 / $20.89	Professional	26	$11.75	$15.85	$20.89
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $39.81 / $56.23	Professional	TC	$28.84	$39.81	$56.23
United Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $83.18	Professional		$37.15	$56.23	$83.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $17.38 / $22.91	Professional	26	$10.47	$17.38	$22.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $39.81 / $58.88	Professional	TC	$27.54	$39.81	$58.88
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $79.43	Professional		$67.61	$79.43	$79.43
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $21.38 / $21.38	Professional	26	$18.20	$21.38	$21.38
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $57.54 / $57.54	Professional	TC	$48.98	$57.54	$57.54