Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $12.88 / $34.67	Facility	26	$8.71	$12.88	$34.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $38.90 / $104.71	Professional		$23.44	$38.90	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $12.02 / $30.90	Professional	26	$7.59	$12.02	$30.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $33.88 / $93.33	Professional	52	$30.20	$33.88	$93.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $24.55 / $54.95	Professional	TC	$15.85	$24.55	$54.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $28.84 / $53.70	Professional		$19.95	$28.84	$53.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $8.91 / $11.75	Professional	26	$7.94	$8.91	$11.75
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $4.47 / $4.47 / $5.25	Professional	52	$4.47	$4.47	$5.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	TC	$36.31	$36.31	$36.31
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $41.69 / $66.07	Professional		$32.36	$41.69	$66.07
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $13.18 / $22.39	Professional	26	$10.47	$13.18	$22.39
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $28.18 / $44.67	Professional	TC	$21.88	$28.18	$44.67
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $30.90 / $30.90	Professional		$30.90	$30.90	$30.90
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $10.00 / $10.00	Professional	26	$10.00	$10.00	$10.00
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $20.89 / $20.89	Professional	TC	$20.89	$20.89	$20.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $41.69 / $70.79	Professional		$26.30	$41.69	$70.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.30 / $21.38	Professional	26	$8.32	$12.30	$21.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $28.84 / $50.12	Professional	TC	$17.78	$28.84	$50.12
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $2.19 / $10.23 / $14.79	Facility	26	$2.19	$10.23	$14.79
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $38.90 / $75.86	Professional		$25.12	$38.90	$75.86
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $12.30 / $22.91	Professional	26	$8.13	$12.30	$22.91
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $27.54 / $54.95	Professional	TC	$17.38	$27.54	$54.95
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 $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $37.15 / $66.07	Professional		$29.51	$37.15	$66.07
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $11.75 / $21.38	Professional	26	$9.55	$11.75	$21.38
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $25.12 / $44.67	Professional	TC	$20.42	$25.12	$44.67
United Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $35.48 / $57.54	Professional		$25.70	$35.48	$57.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $10.72 / $17.38	Professional	26	$7.76	$10.72	$17.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $23.99 / $39.81	Professional	TC	$17.38	$23.99	$39.81