Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.88 / $19.05 / $29.51	Facility	26	$12.88	$19.05	$29.51
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $28.84 / $66.07 / $436.52	Facility	TC	$28.84	$66.07	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $50.12 / $147.91	Professional		$37.15	$50.12	$147.91
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $20.42 / $58.88	Professional	26	$12.02	$20.42	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $32.36 / $83.18	Professional	TC	$25.12	$32.36	$83.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $35.48 / $47.86	Professional		$28.84	$35.48	$47.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $16.98 / $19.05	Professional	26	$15.85	$16.98	$19.05
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $58.88 / $93.33	Professional		$43.65	$58.88	$93.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.39 / $35.48	Professional	26	$16.98	$22.39	$35.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $36.31 / $56.23	Professional	TC	$28.18	$36.31	$56.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $52.48 / $74.13	Professional		$52.48	$52.48	$74.13
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $16.60 / $23.44	Professional	26	$16.60	$16.60	$23.44
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $36.31 / $51.29	Professional	TC	$36.31	$36.31	$51.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	TC	$7.24	$33.88	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $58.88 / $100.00	Professional		$38.02	$58.88	$100.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $19.50 / $34.67	Professional	26	$12.30	$19.50	$34.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $39.81 / $67.61	Professional	TC	$25.12	$39.81	$67.61
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $3.24 / $15.14 / $21.88	Facility	26	$3.24	$15.14	$21.88
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $7.08 / $32.36 / $46.77	Facility	TC	$7.08	$32.36	$46.77
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $56.23 / $104.71	Professional		$36.31	$56.23	$104.71
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $19.05 / $36.31	Professional	26	$12.30	$19.05	$36.31
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.90 / $69.18	Professional	TC	$25.12	$38.90	$69.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $32.36 / $33.11	Professional		$26.30	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Facility Modifier TC Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	TC	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $52.48 / $95.50	Professional		$42.66	$52.48	$95.50
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $16.60 / $29.51	Professional	26	$13.49	$16.60	$29.51
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $36.31 / $66.07	Professional	TC	$29.51	$36.31	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $48.98 / $81.28	Professional		$35.48	$48.98	$81.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $16.98 / $27.54	Professional	26	$12.02	$16.98	$27.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $53.70	Professional	TC	$23.44	$31.62	$53.70