Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.50 / $14.50 / $14.50	Facility	26	$14.50	$14.50	$14.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $42.08 / $42.08 / $42.08	Facility	TC	$42.08	$42.08	$42.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.17 / $48.70 / $91.23	Professional		$47.17	$48.70	$91.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.39 / $14.50 / $50.73	Professional	26	$13.39	$14.50	$50.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.14 / $40.04 / $117.90	Professional	TC	$33.14	$40.04	$117.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $103.40 / $126.44 / $158.05	Professional		$103.40	$126.44	$158.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.01 / $31.80 / $39.75	Professional	26	$26.01	$31.80	$39.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.72 / $94.64 / $118.29	Professional	TC	$75.72	$94.64	$118.29
Medica Facility/Professional Professional Modifier Low / Median / High Price $58.07 / $96.63 / $345.18	Professional		$58.07	$96.63	$345.18
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $17.92 / $27.62 / $89.67	Professional	26	$17.92	$27.62	$89.67
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $40.65 / $67.76 / $255.46	Professional	TC	$40.65	$67.76	$255.46
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $63.53 / $63.53 / $63.53	Facility	26	$63.53	$63.53	$63.53
Midlands Facility/Professional Facility Modifier TC Low / Median / High Price $138.76 / $138.76 / $138.76	Facility	TC	$138.76	$138.76	$138.76
Midlands Facility/Professional Professional Modifier Low / Median / High Price $93.42 / $110.90 / $135.91	Professional		$93.42	$110.90	$135.91
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $60.98 / $89.08 / $104.80	Professional		$60.98	$89.08	$104.80
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $15.50 / $23.83 / $27.17	Professional	26	$15.50	$23.83	$27.17
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $40.33 / $65.98 / $77.63	Professional	TC	$40.33	$65.98	$77.63
United Facility/Professional Professional Modifier Low / Median / High Price $62.68 / $96.63 / $119.66	Professional		$62.68	$96.63	$119.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.78 / $23.20 / $30.00	Professional	26	$16.78	$23.20	$30.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.75 / $54.22 / $69.01	Professional	TC	$42.75	$54.22	$69.01
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $92.50 / $108.80 / $108.80	Professional		$92.50	$108.80	$108.80
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $28.20 / $28.20	Professional	26	$24.00	$28.20	$28.20
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $68.50 / $80.59 / $80.59	Professional	TC	$68.50	$80.59	$80.59