Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $44.67 / $69.18	Facility	26	$35.48	$44.67	$69.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $144.54 / $363.08	Professional		$74.13	$144.54	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $64.57 / $181.97	Professional	26	$33.11	$64.57	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $57.54 / $173.78	Professional	TC	$38.90	$57.54	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $79.43 / $131.83	Professional		$61.66	$79.43	$131.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $36.31 / $60.26	Professional	26	$28.18	$36.31	$60.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $75.86	Professional	TC	$34.67	$45.71	$75.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $114.82 / $177.83	Professional		$83.18	$114.82	$177.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $46.77 / $77.62	Professional	26	$31.62	$46.77	$77.62
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $63.10 / $102.33	Professional	TC	$52.48	$63.10	$102.33
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $114.82 / $151.36	Professional		$107.15	$114.82	$151.36
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $50.12 / $66.07	Professional	26	$46.77	$50.12	$66.07
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $64.57 / $85.11	Professional	TC	$60.26	$64.57	$85.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $56.23 / $107.15	Professional		$37.15	$56.23	$107.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $173.78	Professional		$75.86	$109.65	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $47.86 / $75.86	Professional	26	$32.36	$47.86	$75.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $66.07 / $102.33	Professional	TC	$41.69	$66.07	$102.33
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $109.65 / $173.78	Professional		$70.79	$109.65	$173.78
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $48.98 / $85.11	Professional	26	$32.36	$48.98	$85.11
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $102.33	Professional	TC	$41.69	$61.66	$102.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $33.11 / $51.29	Professional		$27.54	$33.11	$51.29
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 $87.10 / $107.15 / $190.55	Professional		$87.10	$107.15	$190.55
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $46.77 / $83.18	Professional	26	$38.02	$46.77	$83.18
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $60.26 / $109.65	Professional	TC	$48.98	$60.26	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $95.50 / $151.36	Professional		$70.79	$95.50	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $66.07	Professional	26	$30.20	$40.74	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $52.48 / $81.28	Professional	TC	$38.90	$52.48	$81.28