Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $12.59 / $19.95	Facility	26	$10.47	$12.59	$19.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $48.98 / $131.83	Professional		$31.62	$48.98	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $16.60 / $33.11	Professional	26	$8.91	$16.60	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $32.36 / $79.43	Professional	TC	$21.88	$32.36	$79.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $33.11 / $51.29	Professional		$28.84	$33.11	$51.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.00 / $18.62	Professional	26	$7.94	$10.00	$18.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $34.67 / $45.71	Professional	TC	$26.30	$34.67	$45.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $39.81 / $64.57	Professional		$30.90	$39.81	$64.57
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $12.88 / $20.42	Professional	26	$9.77	$12.88	$20.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $26.92 / $43.65	Professional	TC	$19.95	$26.92	$43.65
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $44.67 / $46.77	Professional		$41.69	$44.67	$46.77
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $12.59 / $13.18	Professional	26	$12.02	$12.59	$13.18
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $31.62 / $33.88	Professional	TC	$30.20	$31.62	$33.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.22 / $31.62 / $56.23	Professional		$11.22	$31.62	$56.23
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 $30.90 / $45.71 / $79.43	Professional		$30.90	$45.71	$79.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.18 / $22.39	Professional	26	$8.91	$13.18	$22.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $33.11 / $60.26	Professional	TC	$22.39	$33.11	$60.26
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 $30.20 / $44.67 / $81.28	Professional		$30.20	$44.67	$81.28
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $13.49 / $26.30	Professional	26	$8.91	$13.49	$26.30
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $32.36 / $61.66	Professional	TC	$21.88	$32.36	$61.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.60 / $32.36 / $33.11	Professional		$16.60	$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 $38.02 / $46.77 / $83.18	Professional		$38.02	$46.77	$83.18
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $13.18 / $23.44	Professional	26	$10.72	$13.18	$23.44
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $33.88 / $60.26	Professional	TC	$27.54	$33.88	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $38.02 / $66.07	Professional		$29.51	$38.02	$66.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $11.22 / $19.95	Professional	26	$8.32	$11.22	$19.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $26.92 / $46.77	Professional	TC	$19.95	$26.92	$46.77