Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.21 / $13.21 / $13.21	Facility	26	$13.21	$13.21	$13.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.74 / $40.64 / $76.14	Professional		$38.74	$40.64	$76.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.25 / $18.47 / $45.90	Professional	26	$12.25	$18.47	$45.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $20.32 / $20.32 / $23.56	Professional	52	$20.32	$20.32	$23.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.21 / $32.08 / $90.78	Professional	TC	$25.21	$32.08	$90.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $83.40 / $105.50 / $131.87	Professional		$83.40	$105.50	$131.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.11 / $29.48 / $36.85	Professional	26	$24.11	$29.48	$36.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.28 / $76.02 / $95.02	Professional	TC	$50.28	$76.02	$95.02
Medica Facility/Professional Professional Modifier Low / Median / High Price $42.72 / $74.76 / $290.45	Professional		$42.72	$74.76	$290.45
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $25.20 / $82.68	Professional	26	$16.34	$25.20	$82.68
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $25.58 / $42.64 / $207.72	Professional	TC	$25.58	$42.64	$207.72
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $47.67 / $47.67 / $47.67	Facility	26	$47.67	$47.67	$47.67
Midlands Facility/Professional Professional Modifier Low / Median / High Price $72.00 / $83.40 / $114.23	Professional		$72.00	$83.40	$114.23
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $44.11 / $65.59 / $87.98	Professional		$44.11	$65.59	$87.98
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $17.36 / $23.42 / $25.23	Professional	26	$17.36	$23.42	$25.23
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $28.12 / $46.78 / $62.75	Professional	TC	$28.12	$46.78	$62.75
United Facility/Professional Professional Modifier Low / Median / High Price $48.44 / $65.36 / $81.53	Professional		$48.44	$65.36	$81.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.58 / $18.71 / $29.99	Professional	26	$15.58	$18.71	$29.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.19 / $42.64 / $56.33	Professional	TC	$33.19	$42.64	$56.33
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.80 / $98.60 / $98.60	Professional		$83.80	$98.60	$98.60
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $28.30 / $28.30	Professional	26	$24.00	$28.30	$28.30
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $59.80 / $70.30 / $70.30	Professional	TC	$59.80	$70.30	$70.30