Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.72 / $14.45 / $19.95	Facility	26	$10.72	$14.45	$19.95
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $38.02 / $251.19 / $851.14	Facility	TC	$38.02	$251.19	$851.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $54.95 / $181.97	Professional		$18.62	$54.95	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $22.39 / $66.07	Professional	26	$10.00	$22.39	$66.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $40.74 / $125.89 / $380.19	Professional	50	$40.74	$125.89	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $47.86 / $114.82	Professional	TC	$28.18	$47.86	$114.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $38.90 / $67.61	Professional		$31.62	$38.90	$67.61
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $13.49 / $19.95	Professional	26	$8.51	$13.49	$19.95
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $51.29 / $67.61 / $128.82	Professional	50	$51.29	$67.61	$128.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $40.74 / $66.07	Professional	TC	$25.70	$40.74	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $43.65 / $72.44	Professional		$33.88	$43.65	$72.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.72 / $14.79 / $23.44	Professional	26	$10.72	$14.79	$23.44
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $50.12 / $66.07 / $107.15	Professional	50	$50.12	$66.07	$107.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $28.84 / $51.29	Professional	TC	$21.88	$28.84	$51.29
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $58.88 / $93.33	Professional		$50.12	$58.88	$93.33
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $12.30 / $13.80 / $21.88	Professional	26	$12.30	$13.80	$21.88
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $45.71 / $70.79	Professional	TC	$38.02	$45.71	$70.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.48 / $39.81 / $67.61	Professional		$11.48	$39.81	$67.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $8.51 / $39.81 / $56.23	Facility	TC	$8.51	$39.81	$56.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $53.70 / $95.50	Professional		$36.31	$53.70	$95.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $14.79 / $25.12	Professional	26	$9.55	$14.79	$25.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $38.90 / $74.13	Professional	TC	$25.70	$38.90	$74.13
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $2.69 / $12.59 / $17.78	Facility	26	$2.69	$12.59	$17.78
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $8.13 / $48.98 / $371.54	Facility	TC	$8.13	$48.98	$371.54
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $52.48 / $102.33	Professional		$32.36	$52.48	$102.33
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $15.14 / $32.36	Professional	26	$9.55	$15.14	$32.36
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $11.75 / $43.65 / $95.50	Professional	50	$11.75	$43.65	$95.50
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $38.90 / $74.13	Professional	TC	$25.12	$38.90	$74.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $32.36 / $33.11	Professional		$17.38	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $12.59 / $128.82	Facility	26	$12.59	$12.59	$128.82
SummaCare Facility/Professional Facility Modifier TC Low / Median / High Price $38.90 / $38.90 / $128.82	Facility	TC	$38.90	$38.90	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $58.88 / $100.00	Professional		$47.86	$58.88	$100.00
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $11.22 / $14.79 / $25.12	Professional	26	$11.22	$14.79	$25.12
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $45.71 / $72.44	Professional	TC	$37.15	$45.71	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $43.65 / $75.86	Professional		$32.36	$43.65	$75.86
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 $22.39 / $31.62 / $56.23	Professional	TC	$22.39	$31.62	$56.23