Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.14 / $15.14 / $23.99	Facility	26	$15.14	$15.14	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $54.95 / $147.91	Professional		$43.65	$54.95	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $15.85 / $45.71	Professional	26	$14.13	$15.85	$45.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $36.31 / $104.71	Professional	TC	$30.20	$36.31	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $89.13 / $112.20	Professional		$81.28	$89.13	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $28.84 / $36.31	Professional	26	$25.70	$28.84	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $60.26 / $75.86	Professional	TC	$57.54	$60.26	$75.86
Medica Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $91.20 / $537.03	Professional		$45.71	$91.20	$537.03
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $26.92 / $91.20	Professional	26	$15.85	$26.92	$91.20
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $64.57 / $218.78	Professional	TC	$38.02	$64.57	$218.78
Midlands Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $107.15 / $114.82	Professional		$100.00	$107.15	$114.82
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $33.88 / $35.48	Professional	26	$30.20	$33.88	$35.48
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $70.79 / $81.28	Professional	TC	$69.18	$70.79	$81.28
Midlands Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $104.71 / $104.71	Professional		$57.54	$104.71	$104.71
Midlands Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $30.90 / $30.90	Professional	26	$16.22	$30.90	$30.90
Midlands Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $74.13 / $74.13	Professional	TC	$41.69	$74.13	$74.13
Sanford Health Plan Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $70.79 / $91.20	Professional		$47.86	$70.79	$91.20
Sanford Health Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $23.44 / $27.54	Professional	26	$15.85	$23.44	$27.54
Sanford Health Plan Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.98 / $63.10	Professional	TC	$32.36	$48.98	$63.10
United Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $91.20 / $134.90	Professional		$53.70	$91.20	$134.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $27.54 / $39.81	Professional	26	$15.85	$27.54	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $64.57 / $95.50	Professional	TC	$38.02	$64.57	$95.50
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $85.11 / $102.33	Professional		$83.18	$85.11	$102.33
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $28.18 / $33.88	Professional	26	$27.54	$28.18	$33.88
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $57.54 / $67.61	Professional	TC	$54.95	$57.54	$67.61