Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $14.79 / $37.15	Facility	26	$10.47	$14.79	$37.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $52.48 / $165.96	Professional		$33.11	$52.48	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $16.98 / $38.90	Professional	26	$8.91	$16.98	$38.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $36.31 / $83.18	Professional	TC	$23.99	$36.31	$83.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $40.74 / $81.28	Professional		$29.51	$40.74	$81.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $10.23 / $17.38	Professional	26	$9.33	$10.23	$17.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $25.70 / $53.70	Professional	TC	$23.99	$25.70	$53.70
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $52.48 / $81.28	Professional		$38.90	$52.48	$81.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.48 / $14.45 / $24.55	Professional	26	$11.48	$14.45	$24.55
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $37.15 / $60.26	Professional	TC	$27.54	$37.15	$60.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $33.11 / $58.88	Professional		$11.22	$33.11	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $53.70 / $93.33	Professional		$34.67	$53.70	$93.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.45 / $24.55	Professional	26	$9.55	$14.45	$24.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $39.81 / $67.61	Professional	TC	$24.55	$39.81	$67.61
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $2.63 / $12.30 / $17.38	Facility	26	$2.63	$12.30	$17.38
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $52.48 / $93.33	Professional		$32.36	$52.48	$93.33
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.45 / $29.51	Professional	26	$9.55	$14.45	$29.51
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.02 / $70.79	Professional	TC	$23.99	$38.02	$70.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $32.36 / $33.11	Professional		$22.91	$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 / $51.29 / $91.20	Professional		$40.74	$51.29	$91.20
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $13.49 / $23.99	Professional	26	$10.96	$13.49	$23.99
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $37.15 / $67.61	Professional	TC	$30.20	$37.15	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $74.13	Professional		$32.36	$44.67	$74.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $12.02 / $20.89	Professional	26	$8.91	$12.02	$20.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $31.62 / $53.70	Professional	TC	$23.44	$31.62	$53.70