Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.38 / $23.44 / $85.11	Facility	26	$17.38	$23.44	$85.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $114.82 / $263.03	Professional		$77.62	$114.82	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $27.54 / $66.07	Professional	26	$15.49	$27.54	$66.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $91.20 / $186.21	Professional	TC	$63.10	$91.20	$186.21
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $72.44 / $79.43	Professional		$69.18	$72.44	$79.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $18.62 / $31.62	Professional	26	$14.13	$18.62	$31.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $93.33 / $151.36	Professional		$70.79	$93.33	$151.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $23.44 / $38.02	Professional	26	$17.38	$23.44	$38.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $69.18 / $114.82	Professional	TC	$52.48	$69.18	$114.82
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $112.20 / $186.21	Professional		$102.33	$112.20	$186.21
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $21.38 / $34.67	Professional	26	$20.42	$21.38	$34.67
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $91.20 / $147.91	Professional	TC	$83.18	$91.20	$147.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $83.18 / $138.04	Professional		$19.05	$83.18	$138.04
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.47 / $20.89 / $29.51	Facility	26	$4.47	$20.89	$29.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $117.49 / $213.80	Professional		$74.13	$117.49	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $23.99 / $39.81	Professional	26	$15.85	$23.99	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $177.83	Professional	TC	$61.66	$93.33	$177.83
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $4.47 / $20.89 / $29.51	Facility	26	$4.47	$20.89	$29.51
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $112.20 / $218.78	Professional		$67.61	$112.20	$218.78
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $25.12 / $45.71	Professional	26	$16.22	$25.12	$45.71
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $181.97	Professional	TC	$61.66	$93.33	$181.97
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 $95.50 / $123.03 / $213.80	Professional		$95.50	$123.03	$213.80
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $23.99 / $40.74	Professional	26	$18.20	$23.99	$40.74
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $97.72 / $173.78	Professional	TC	$77.62	$97.72	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $100.00 / $165.96	Professional		$72.44	$100.00	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $19.95 / $33.88	Professional	26	$15.14	$19.95	$33.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $79.43 / $134.90	Professional	TC	$56.23	$79.43	$134.90