Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $18.62 / $25.70	Facility	26	$13.18	$18.62	$25.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $47.86 / $120.23	Professional		$33.88	$47.86	$120.23
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 / $30.90 / $75.86	Professional	TC	$22.91	$30.90	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $35.48 / $79.43	Professional		$28.18	$35.48	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $18.20 / $21.38	Professional	26	$11.22	$18.20	$21.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $19.95 / $19.95	Professional	TC	$19.95	$19.95	$19.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $50.12 / $79.43	Professional		$38.90	$50.12	$79.43
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 $24.55 / $31.62 / $51.29	Professional	TC	$24.55	$31.62	$51.29
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $46.77 / $51.29	Professional		$46.77	$46.77	$51.29
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $15.14 / $16.98	Professional	26	$15.14	$15.14	$16.98
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $31.62 / $34.67	Professional	TC	$31.62	$31.62	$34.67
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.39 / $15.85 / $22.39	Facility	26	$3.39	$15.85	$22.39
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $53.70 / $91.20	Professional		$35.48	$53.70	$91.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $17.78 / $29.51	Professional	26	$12.02	$17.78	$29.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $35.48 / $63.10	Professional	TC	$23.99	$35.48	$63.10
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $3.39 / $15.85 / $22.39	Facility	26	$3.39	$15.85	$22.39
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $52.48 / $97.72	Professional		$34.67	$52.48	$97.72
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $17.78 / $33.11	Professional	26	$12.02	$17.78	$33.11
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $35.48 / $64.57	Professional	TC	$23.44	$35.48	$64.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $32.36 / $33.11	Professional		$21.88	$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 $41.69 / $51.29 / $93.33	Professional		$41.69	$51.29	$93.33
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $16.98 / $30.20	Professional	26	$13.80	$16.98	$30.20
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $34.67 / $63.10	Professional	TC	$28.18	$34.67	$63.10
United Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $43.65 / $77.62	Professional		$33.88	$43.65	$77.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $15.14 / $26.30	Professional	26	$11.48	$15.14	$26.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $28.84 / $50.12	Professional	TC	$21.38	$28.84	$50.12