Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $200.01 / $200.01 / $200.01	Facility	TC	$200.01	$200.01	$200.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.21 / $75.89 / $152.37	Professional		$42.21	$75.89	$152.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.09 / $22.40 / $67.40	Professional	26	$9.09	$22.40	$67.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.98 / $64.98 / $136.63	Professional	TC	$44.98	$64.98	$136.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $29.31 / $39.72 / $48.72	Professional		$29.31	$39.72	$48.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.49 / $5.96 / $15.46	Professional	26	$5.49	$5.96	$15.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.80 / $37.44 / $122.01	Professional		$28.80	$37.44	$122.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $5.04 / $6.75 / $20.80	Professional	26	$5.04	$6.75	$20.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.76 / $30.15 / $98.21	Professional	TC	$23.76	$30.15	$98.21
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $51.28 / $58.97 / $134.07	Professional		$51.28	$58.97	$134.07
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $11.04 / $12.70 / $20.20	Professional	26	$11.04	$12.70	$20.20
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $43.55 / $50.08 / $113.86	Professional	TC	$43.55	$50.08	$113.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.06 / $71.55 / $99.06	Facility		$11.06	$71.55	$99.06
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.04 / $73.26 / $120.66	Professional		$11.04	$73.26	$120.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $149.16 / $149.16 / $149.16	Facility		$149.16	$149.16	$149.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.75 / $62.41 / $117.22	Professional		$35.75	$62.41	$117.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.52 / $11.22 / $21.22	Professional	26	$5.52	$11.22	$21.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.58 / $52.16 / $99.55	Professional	TC	$29.58	$52.16	$99.55
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $149.16 / $149.16 / $149.16	Facility		$149.16	$149.16	$149.16
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $32.83 / $67.00 / $130.05	Professional		$32.83	$67.00	$130.05
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $5.52 / $14.64 / $32.97	Professional	26	$5.52	$14.64	$32.97
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $28.93 / $62.22 / $102.66	Professional	TC	$28.93	$62.22	$102.66
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.20 / $73.01 / $107.49	Professional		$44.20	$73.01	$107.49
United Facility/Professional Professional Modifier Low / Median / High Price $42.90 / $65.51 / $121.55	Professional		$42.90	$65.51	$121.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.75 / $12.34 / $20.99	Professional	26	$6.75	$12.34	$20.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.56 / $58.49 / $97.39	Professional	TC	$32.56	$58.49	$97.39