Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $27.54 / $43.65	Facility	26	$22.39	$27.54	$43.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $81.28 / $281.84	Professional		$41.69	$81.28	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $37.15 / $81.28	Professional	26	$19.95	$37.15	$81.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $33.88 / $100.00	Professional	TC	$19.95	$33.88	$100.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $45.71 / $75.86	Professional		$36.31	$45.71	$75.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $20.89 / $42.66	Professional	26	$17.78	$20.89	$42.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $23.44 / $33.11	Professional	TC	$18.62	$23.44	$33.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $83.18 / $131.83	Professional		$58.88	$83.18	$131.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.70 / $40.74	Professional	26	$19.05	$25.70	$40.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $56.23 / $91.20	Professional	TC	$34.67	$56.23	$91.20
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $58.88 / $97.72	Professional		$53.70	$58.88	$97.72
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $28.18 / $46.77	Professional	26	$26.30	$28.18	$46.77
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $30.90 / $50.12	Professional	TC	$27.54	$30.90	$50.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $31.62 / $63.10	Professional		$23.44	$31.62	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $75.86 / $141.25	Professional		$43.65	$75.86	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $27.54 / $45.71	Professional	26	$18.62	$27.54	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $38.90 / $109.65	Professional	TC	$20.89	$38.90	$109.65
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $70.79 / $147.91	Professional		$40.74	$70.79	$147.91
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $29.51 / $53.70	Professional	26	$19.05	$29.51	$53.70
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $37.15 / $109.65	Professional	TC	$20.42	$37.15	$109.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $32.36 / $33.11	Professional		$17.78	$32.36	$33.11
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 $36.31 / $54.95 / $89.13	Professional		$36.31	$54.95	$89.13
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $28.84 / $51.29	Professional	26	$22.91	$28.84	$51.29
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $22.39 / $54.95	Professional	TC	$13.18	$22.39	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $57.54 / $107.15	Professional		$39.81	$57.54	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $25.12 / $39.81	Professional	26	$17.38	$25.12	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $27.54 / $79.43	Professional	TC	$19.50	$27.54	$79.43