Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $15.85 / $26.92	Facility	26	$12.02	$15.85	$26.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $75.86 / $199.53	Professional		$43.65	$75.86	$199.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $20.89 / $52.48	Professional	26	$12.02	$20.89	$52.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $53.70 / $104.71	Professional	TC	$32.36	$53.70	$104.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $43.65 / $83.18	Professional		$34.67	$43.65	$83.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $12.02 / $20.42	Professional	26	$9.55	$12.02	$20.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $38.02 / $69.18	Professional	TC	$30.20	$38.02	$69.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $60.26 / $95.50	Professional		$45.71	$60.26	$95.50
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $19.95 / $32.36	Professional	26	$15.49	$19.95	$32.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $39.81 / $63.10	Professional	TC	$29.51	$39.81	$63.10
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $64.57 / $100.00	Professional		$54.95	$64.57	$100.00
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $16.22 / $25.12	Professional	26	$14.13	$16.22	$25.12
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $47.86 / $75.86	Professional	TC	$40.74	$47.86	$75.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $13.18 / $43.65 / $74.13	Professional		$13.18	$43.65	$74.13
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 $41.69 / $64.57 / $112.20	Professional		$41.69	$64.57	$112.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $18.20 / $31.62	Professional	26	$11.75	$18.20	$31.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $46.77 / $81.28	Professional	TC	$30.20	$46.77	$81.28
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 $37.15 / $57.54 / $114.82	Professional		$37.15	$57.54	$114.82
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $19.05 / $42.66	Professional	26	$11.48	$19.05	$42.66
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $45.71 / $79.43	Professional	TC	$29.51	$45.71	$79.43
Molina Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $32.36 / $33.11	Professional		$24.55	$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 $52.48 / $66.07 / $114.82	Professional		$52.48	$66.07	$114.82
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.60 / $28.84	Professional	26	$12.88	$16.60	$28.84
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $47.86 / $87.10	Professional	TC	$38.90	$47.86	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $53.70 / $89.13	Professional		$38.90	$53.70	$89.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $15.49 / $25.12	Professional	26	$10.96	$15.49	$25.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $37.15 / $63.10	Professional	TC	$28.84	$37.15	$63.10