Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $23.99 / $23.99	Facility	26	$23.99	$23.99	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $57.54 / $114.82	Professional		$38.90	$57.54	$114.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $39.81 / $93.33	Professional	26	$23.44	$39.81	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $22.91 / $77.62	Professional	TC	$15.14	$22.91	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $97.72 / $123.03	Professional		$89.13	$97.72	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $57.54 / $70.79	Professional	26	$52.48	$57.54	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $40.74 / $50.12	Professional	TC	$37.15	$40.74	$50.12
Medica Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $85.11 / $141.25	Professional		$40.74	$85.11	$141.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $33.11 / $50.12	Professional	26	$25.70	$33.11	$50.12
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $53.70 / $93.33	Professional	TC	$20.42	$53.70	$93.33
Midlands Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Professional		$117.49	$117.49	$117.49
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $56.23	Professional	26	$56.23	$56.23	$56.23
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $63.10	Professional	TC	$63.10	$63.10	$63.10
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $79.43 / $134.90	Professional		$58.88	$79.43	$134.90
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $40.74 / $46.77	Professional	26	$32.36	$40.74	$46.77
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.11 / $89.13	Professional	TC	$24.55	$33.11	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $87.10 / $134.90	Professional		$46.77	$87.10	$134.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $37.15 / $52.48	Professional	26	$26.92	$37.15	$52.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $43.65 / $89.13	Professional	TC	$18.62	$43.65	$89.13
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $89.13 / $89.13	Professional		$75.86	$89.13	$89.13
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $52.48 / $52.48	Professional	26	$44.67	$52.48	$52.48
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $37.15 / $37.15	Professional	TC	$31.62	$37.15	$37.15