Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $51.29 / $107.15	Facility	26	$38.02	$51.29	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $100.00 / $371.54	Professional		$70.79	$100.00	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $141.25	Professional	26	$35.48	$45.71	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $50.12 / $190.55	Professional	TC	$33.88	$50.12	$190.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $77.62 / $154.88	Professional		$52.48	$77.62	$154.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $39.81 / $67.61	Professional	26	$28.84	$39.81	$67.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $125.89 / $223.87	Professional		$87.10	$125.89	$223.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $54.95 / $89.13	Professional	26	$39.81	$54.95	$89.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $72.44 / $123.03	Professional	TC	$42.66	$72.44	$123.03
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $112.20 / $151.36	Professional		$85.11	$112.20	$151.36
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $54.95 / $72.44	Professional	26	$41.69	$54.95	$72.44
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $57.54 / $77.62	Professional	TC	$43.65	$57.54	$77.62
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $57.54 / $107.15	Professional		$37.15	$57.54	$107.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $42.66 / $61.66	Facility	26	$9.12	$42.66	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $109.65 / $213.80	Professional		$63.10	$109.65	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $51.29 / $87.10	Professional	26	$33.88	$51.29	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $56.23 / $138.04	Professional	TC	$30.20	$56.23	$138.04
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $9.12 / $42.66 / $61.66	Facility	26	$9.12	$42.66	$61.66
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $104.71 / $223.87	Professional		$61.66	$104.71	$223.87
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $50.12 / $87.10	Professional	26	$30.90	$50.12	$87.10
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $56.23 / $141.25	Professional	TC	$28.84	$56.23	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $97.72 / $173.78	Professional		$77.62	$97.72	$173.78
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $47.86 / $85.11	Professional	26	$38.02	$47.86	$85.11
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $50.12 / $89.13	Professional	TC	$39.81	$50.12	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $87.10 / $173.78	Professional		$61.66	$87.10	$173.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $42.66 / $75.86	Professional	26	$32.36	$42.66	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $39.81 / $114.82	Professional	TC	$26.30	$39.81	$114.82