Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility		$1,000.00	$1,000.00	$1,000.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $75.86 / $223.87	Professional		$52.48	$75.86	$223.87
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $81.28 / $81.28 / $81.28	Professional	25	$81.28	$81.28	$81.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.18 / $114.82	Professional	26	$21.88	$28.18	$114.82
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $389.05 / $389.05 / $389.05	Professional	50	$389.05	$389.05	$389.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.12 / $234.42 / $257.04	Professional	52	$50.12	$234.42	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $34.67 / $70.79	Professional	TC	$26.92	$34.67	$70.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $57.54 / $60.26	Professional		$54.95	$57.54	$60.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $33.11 / $33.11	Professional	TC	$33.11	$33.11	$33.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $74.13 / $144.54	Professional		$53.70	$74.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $28.18 / $53.70	Professional	26	$22.39	$28.18	$53.70
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $85.11 / $114.82 / $218.78	Professional	50	$85.11	$114.82	$218.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $44.67 / $75.86	Professional	TC	$31.62	$44.67	$75.86
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $77.62	Professional		$57.54	$57.54	$77.62
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $24.55 / $33.11	Professional	26	$24.55	$24.55	$33.11
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $32.36 / $44.67	Professional	TC	$32.36	$32.36	$44.67
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $34.67 / $74.13	Facility		$25.12	$34.67	$74.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $33.88 / $64.57	Professional		$24.55	$33.88	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $70.79 / $117.49	Professional		$48.98	$70.79	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.20 / $47.86	Professional	26	$20.89	$30.20	$47.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $39.81 / $81.28	Professional	TC	$27.54	$39.81	$81.28
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $67.61 / $114.82	Professional		$48.98	$67.61	$114.82
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $29.51 / $48.98	Professional	26	$20.89	$29.51	$48.98
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $38.90 / $81.28	Professional	TC	$27.54	$38.90	$81.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $32.36 / $33.11	Professional		$16.98	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $74.13 / $125.89	Professional		$63.10	$74.13	$125.89
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $31.62 / $43.65	Professional	26	$26.92	$31.62	$43.65
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $41.69 / $83.18	Professional	TC	$36.31	$41.69	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $15.14 / $28.84 / $43.65	Facility		$15.14	$28.84	$43.65
United Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $57.54 / $91.20	Professional		$42.66	$57.54	$91.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $24.55 / $38.02	Professional	26	$19.05	$24.55	$38.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $33.11 / $53.70	Professional	TC	$24.55	$33.11	$53.70