Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $43.65 / $117.49	Facility	26	$25.70	$43.65	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $109.65 / $223.87	Professional		$83.18	$109.65	$223.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $38.02 / $177.83	Professional	26	$22.91	$38.02	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $81.28 / $151.36	Professional	TC	$61.66	$81.28	$151.36
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $58.88	Professional		$57.54	$57.54	$58.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $18.62 / $33.88	Professional	26	$15.49	$18.62	$33.88
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $44.67 / $44.67	Professional	TC	$44.67	$44.67	$44.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $67.61 / $165.96	Professional		$53.70	$67.61	$165.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $18.62 / $45.71	Professional	26	$14.79	$18.62	$45.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $120.23	Professional	TC	$38.90	$48.98	$120.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $239.88	Professional		$239.88	$239.88	$239.88
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $63.10 / $63.10	Professional	26	$63.10	$63.10	$63.10
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	TC	$173.78	$173.78	$173.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $87.10 / $190.55	Professional		$48.98	$87.10	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.99 / $50.12	Professional	26	$14.13	$23.99	$50.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $58.88 / $141.25	Professional	TC	$34.67	$58.88	$141.25
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $75.86 / $186.21	Professional		$48.98	$75.86	$186.21
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $26.30 / $51.29	Professional	26	$15.49	$26.30	$51.29
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $54.95 / $134.90	Professional	TC	$34.67	$54.95	$134.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $144.54 / $275.42	Professional		$123.03	$144.54	$275.42
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $39.81 / $72.44	Professional	26	$32.36	$39.81	$72.44
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $107.15 / $199.53	Professional	TC	$89.13	$107.15	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $97.72 / $181.97	Professional		$58.88	$97.72	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $28.18 / $46.77	Professional	26	$16.60	$28.18	$46.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $69.18 / $134.90	Professional	TC	$41.69	$69.18	$134.90