Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.96 / $10.96 / $10.96	Facility	26	$10.96	$10.96	$10.96
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $56.23 / $398.11 / $776.25	Facility	TC	$56.23	$398.11	$776.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $54.95 / $173.78	Professional		$17.38	$54.95	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $21.38 / $56.23	Professional	26	$10.47	$21.38	$56.23
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $190.55 / $275.42	Professional	50	$83.18	$190.55	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $70.79 / $239.88	Professional	TC	$33.11	$70.79	$239.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $141.25	Professional		$91.20	$112.20	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.12 / $31.62	Professional	26	$20.42	$25.12	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $87.10 / $109.65	Professional	TC	$70.79	$87.10	$109.65
Medica Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $60.26 / $112.20	Professional		$39.81	$60.26	$112.20
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $20.42 / $28.18	Professional	26	$12.30	$20.42	$28.18
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $45.71 / $229.09	Professional	TC	$28.18	$45.71	$229.09
Midlands Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $91.20 / $100.00	Professional		$91.20	$91.20	$100.00
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $23.44 / $26.30	Professional	26	$22.39	$23.44	$26.30
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $69.18 / $77.62	Professional	TC	$66.07	$69.18	$77.62
Midlands Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Professional		$89.13	$89.13	$89.13
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $23.44 / $23.44	Professional	26	$23.44	$23.44	$23.44
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	TC	$66.07	$66.07	$66.07
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $91.20	Professional		$47.86	$67.61	$91.20
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $18.62 / $21.38	Professional	26	$13.49	$18.62	$21.38
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $48.98 / $70.79	Professional	TC	$36.31	$48.98	$70.79
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $67.61 / $100.00	Professional		$43.65	$67.61	$100.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $19.05 / $24.55	Professional	26	$11.75	$19.05	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $48.98 / $72.44	Professional	TC	$31.62	$48.98	$72.44
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $95.50 / $95.50	Professional		$81.28	$95.50	$95.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $22.39 / $22.39	Professional	26	$18.62	$22.39	$22.39
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $72.44 / $72.44	Professional	TC	$61.66	$72.44	$72.44