Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $12.88 / $12.88	Facility	26	$12.88	$12.88	$12.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $32.36 / $46.77 / $295.12	Facility	TC	$32.36	$46.77	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $44.67 / $123.03	Professional		$38.02	$44.67	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.98 / $32.36	Professional	26	$12.02	$16.98	$32.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $32.36 / $46.77	Professional	TC	$26.92	$32.36	$46.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $102.33 / $125.89	Professional		$81.28	$102.33	$125.89
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 $57.54 / $72.44 / $91.20	Professional	TC	$57.54	$72.44	$91.20
Medica Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $58.88 / $97.72	Professional		$40.74	$58.88	$97.72
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $20.89 / $38.02	Professional	26	$13.49	$20.89	$38.02
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.02 / $72.44	Professional	TC	$25.12	$38.02	$72.44
Midlands Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $89.13 / $91.20	Professional		$83.18	$89.13	$91.20
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $26.92 / $31.62	Professional	26	$25.70	$26.92	$31.62
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $58.88 / $64.57	Professional	TC	$57.54	$58.88	$64.57
Midlands Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Professional		$85.11	$85.11	$85.11
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $27.54 / $27.54	Professional	26	$27.54	$27.54	$27.54
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $57.54 / $57.54	Professional	TC	$57.54	$57.54	$57.54
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $70.79 / $83.18	Professional		$50.12	$70.79	$83.18
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $21.38 / $24.55	Professional	26	$15.49	$21.38	$24.55
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $51.29 / $58.88	Professional	TC	$35.48	$51.29	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $61.66 / $95.50	Professional		$43.65	$61.66	$95.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $21.88 / $29.51	Professional	26	$14.79	$21.88	$29.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $64.57	Professional	TC	$28.18	$40.74	$64.57
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $85.11 / $85.11	Professional		$72.44	$85.11	$85.11
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 $51.29 / $60.26 / $60.26	Professional	TC	$51.29	$60.26	$60.26