Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $44.67 / $128.82	Facility	26	$34.67	$44.67	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $151.36 / $323.59	Professional		$100.00	$151.36	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $48.98 / $141.25	Professional	26	$34.67	$48.98	$141.25
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	50	$602.56	$602.56	$602.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $93.33 / $208.93	Professional	TC	$57.54	$93.33	$208.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $144.54 / $181.97	Professional		$131.83	$144.54	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $54.95 / $54.95	Professional	26	$54.95	$54.95	$54.95
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $154.88 / $154.88 / $229.09	Professional	50	$154.88	$154.88	$229.09
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $138.04 / $251.19	Professional		$100.00	$138.04	$251.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.29 / $85.11	Professional	26	$38.90	$51.29	$85.11
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $151.36 / $208.93 / $371.54	Professional	50	$151.36	$208.93	$371.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $85.11 / $165.96	Professional	TC	$54.95	$85.11	$165.96
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $128.82 / $223.87	Professional		$42.66	$128.82	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $46.77 / $67.61	Facility	26	$10.00	$46.77	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $162.18 / $263.03	Professional		$100.00	$162.18	$263.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $54.95 / $89.13	Professional	26	$36.31	$54.95	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $109.65 / $190.55	Professional	TC	$56.23	$109.65	$190.55
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $46.77 / $67.61	Facility	26	$10.00	$46.77	$67.61
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $169.82 / $251.19	Professional		$93.33	$169.82	$251.19
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $54.95 / $87.10	Professional	26	$35.48	$54.95	$87.10
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $109.65 / $169.82	Professional	TC	$56.23	$109.65	$169.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $32.36 / $34.67	Professional		$20.89	$32.36	$34.67
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Facility	26	$263.03	$263.03	$263.03
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $190.55 / $346.74	Professional		$158.49	$190.55	$346.74
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $52.48 / $93.33	Professional	26	$42.66	$52.48	$93.33
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $134.90 / $257.04	Professional	TC	$114.82	$134.90	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $123.03 / $204.17	Professional		$85.11	$123.03	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $85.11	Professional	26	$35.48	$45.71	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $74.13 / $134.90	Professional	TC	$47.86	$74.13	$134.90