Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $41.69 / $102.33	Facility	26	$28.84	$41.69	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $173.78	Professional		$54.95	$70.79	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $30.20 / $72.44	Professional	26	$22.91	$30.20	$72.44
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $223.87 / $257.04	Professional	50	$66.07	$223.87	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $38.90 / $77.62	Professional	TC	$28.84	$38.90	$77.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $53.70 / $66.07	Professional		$52.48	$53.70	$66.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $25.12 / $47.86	Professional	26	$23.44	$25.12	$47.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $89.13 / $141.25	Professional		$69.18	$89.13	$141.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $38.02 / $58.88	Professional	26	$28.84	$38.02	$58.88
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $104.71 / $134.90 / $213.80	Professional	50	$104.71	$134.90	$213.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $51.29 / $81.28	Professional	TC	$41.69	$51.29	$81.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $45.71 / $83.18	Professional		$30.20	$45.71	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $91.20 / $144.54	Professional		$58.88	$91.20	$144.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.02 / $60.26	Professional	26	$25.70	$38.02	$60.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $53.70 / $85.11	Professional	TC	$30.90	$53.70	$85.11
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $87.10 / $144.54	Professional		$58.88	$87.10	$144.54
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.02 / $60.26	Professional	26	$25.70	$38.02	$60.26
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $51.29 / $87.10	Professional	TC	$30.20	$51.29	$87.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $32.36 / $35.48	Professional		$23.44	$32.36	$35.48
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 $67.61 / $85.11 / $151.36	Professional		$67.61	$85.11	$151.36
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $38.02 / $67.61	Professional	26	$30.20	$38.02	$67.61
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $46.77 / $83.18	Professional	TC	$38.02	$46.77	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $74.13 / $117.49	Professional		$52.48	$74.13	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $31.62 / $51.29	Professional	26	$23.99	$31.62	$51.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $39.81 / $64.57	Professional	TC	$28.84	$39.81	$64.57