Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $25.70 / $66.07	Facility	26	$16.98	$25.70	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $162.18	Professional		$32.36	$44.67	$162.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.91 / $89.13	Professional	26	$16.98	$22.91	$89.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $16.98 / $93.33	Professional	TC	$12.88	$16.98	$93.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $35.48 / $57.54	Professional		$34.67	$35.48	$57.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $22.39 / $22.39	Professional	26	$22.39	$22.39	$22.39
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $117.49 / $213.80	Professional		$41.69	$117.49	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $40.74 / $69.18	Professional	26	$22.91	$40.74	$69.18
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $63.10 / $177.83 / $323.59	Professional	50	$63.10	$177.83	$323.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $75.86 / $147.91	Professional	TC	$19.95	$75.86	$147.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.13 / $23.99 / $33.88	Facility	26	$5.13	$23.99	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $60.26 / $165.96	Professional		$35.48	$60.26	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $31.62 / $58.88	Professional	26	$19.50	$31.62	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $25.70 / $114.82	Professional	TC	$15.14	$25.70	$114.82
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $5.13 / $23.99 / $33.88	Facility	26	$5.13	$23.99	$33.88
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $58.88 / $177.83	Professional		$33.11	$58.88	$177.83
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $30.90 / $58.88	Professional	26	$18.62	$30.90	$58.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $13.80 / $24.55 / $123.03	Professional	TC	$13.80	$24.55	$123.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $32.36 / $33.11	Professional		$21.38	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $162.18 / $162.18 / $162.18	Facility	26	$162.18	$162.18	$162.18
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $47.86 / $87.10	Professional		$38.90	$47.86	$87.10
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $26.30 / $47.86	Professional	26	$21.38	$26.30	$47.86
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $21.88 / $38.90	Professional	TC	$17.78	$21.88	$38.90
United Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $48.98 / $151.36	Professional		$33.11	$48.98	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $27.54 / $48.98	Professional	26	$18.20	$27.54	$48.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $13.49 / $20.42 / $107.15	Professional	TC	$13.49	$20.42	$107.15