Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $15.14 / $23.99	Facility	26	$12.30	$15.14	$23.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $43.65 / $123.03	Professional		$17.78	$43.65	$123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $19.50 / $44.67	Professional	26	$10.96	$19.50	$44.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $38.02 / $81.28	Professional	TC	$22.91	$38.02	$81.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $33.11 / $74.13	Professional		$26.92	$33.11	$74.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $14.79 / $22.91	Professional	26	$9.33	$14.79	$22.91
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $30.90 / $46.77	Professional	TC	$20.89	$30.90	$46.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $45.71 / $74.13	Professional		$35.48	$45.71	$74.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $18.20 / $28.18	Professional	26	$13.80	$18.20	$28.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.18 / $45.71	Professional	TC	$20.89	$28.18	$45.71
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $47.86 / $79.43	Professional		$44.67	$47.86	$79.43
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $15.14 / $25.12	Professional	26	$14.13	$15.14	$25.12
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $32.36 / $53.70	Professional	TC	$30.90	$32.36	$53.70
CareSource Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $32.36 / $58.88	Professional		$13.18	$32.36	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $50.12 / $87.10	Professional		$33.88	$50.12	$87.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $16.98 / $28.84	Professional	26	$11.48	$16.98	$28.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $33.88 / $61.66	Professional	TC	$22.91	$33.88	$61.66
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $3.09 / $14.45 / $20.89	Facility	26	$3.09	$14.45	$20.89
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $46.77 / $87.10	Professional		$31.62	$46.77	$87.10
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $17.78 / $37.15	Professional	26	$11.22	$17.78	$37.15
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $33.88 / $63.10	Professional	TC	$22.39	$33.88	$63.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $32.36 / $33.11	Professional		$20.42	$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 Professional Modifier Low / Median / High Price $40.74 / $53.70 / $91.20	Professional		$40.74	$53.70	$91.20
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.98 / $28.84	Professional	26	$12.88	$16.98	$28.84
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $35.48 / $61.66	Professional	TC	$28.18	$35.48	$61.66
United Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $41.69 / $70.79	Professional		$31.62	$41.69	$70.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $14.45 / $24.55	Professional	26	$10.47	$14.45	$24.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $27.54 / $47.86	Professional	TC	$20.89	$27.54	$47.86