Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $12.30 / $26.30	Facility	26	$9.55	$12.30	$26.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $39.81 / $275.42	Professional		$22.91	$39.81	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.91 / $11.48 / $51.29	Professional	26	$8.91	$11.48	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $22.91 / $169.82	Professional	TC	$12.88	$22.91	$169.82
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $26.30 / $41.69	Professional		$17.38	$26.30	$41.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $11.22 / $16.98	Professional	26	$7.76	$11.22	$16.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $51.29 / $89.13	Professional		$31.62	$51.29	$89.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $13.80 / $22.91	Professional	26	$10.00	$13.80	$22.91
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $21.38 / $36.31 / $64.57	Professional	TC	$21.38	$36.31	$64.57
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $30.90 / $47.86	Professional		$27.54	$30.90	$47.86
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $12.02 / $18.62	Professional	26	$10.47	$12.02	$18.62
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $19.05 / $29.51	Professional	TC	$16.98	$19.05	$29.51
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.77 / $19.50 / $35.48	Professional		$9.77	$19.50	$35.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.29 / $10.72 / $15.14	Facility	26	$2.29	$10.72	$15.14
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $3.09 / $5.13 / $7.94	Facility	53	$3.09	$5.13	$7.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $37.15 / $144.54	Professional		$20.89	$37.15	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $12.88 / $21.88	Professional	26	$8.32	$12.88	$21.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $12.59 / $22.91 / $128.82	Professional	TC	$12.59	$22.91	$128.82
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $2.29 / $10.72 / $15.14	Facility	26	$2.29	$10.72	$15.14
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $3.09 / $4.90 / $7.94	Facility	53	$3.09	$4.90	$7.94
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $34.67 / $144.54	Professional		$19.50	$34.67	$144.54
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $12.02 / $21.88	Professional	26	$7.24	$12.02	$21.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $12.30 / $22.39 / $131.83	Professional	TC	$12.30	$22.39	$131.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.49 / $32.36 / $33.11	Professional		$15.49	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.88 / $56.23	Professional		$25.12	$33.88	$56.23
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $12.88 / $21.38	Professional	26	$9.55	$12.88	$21.38
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $20.89 / $33.88	Professional	TC	$15.49	$20.89	$33.88
United Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $28.84 / $123.03	Professional		$19.95	$28.84	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.13 / $10.72 / $19.05	Professional	26	$8.13	$10.72	$19.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $16.22 / $104.71	Professional	TC	$11.22	$16.22	$104.71