Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $54.95 / $97.72	Facility	26	$32.36	$54.95	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $138.04	Professional		$54.95	$74.13	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $36.31 / $87.10	Professional	26	$28.18	$36.31	$87.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $36.31 / $64.57	Professional	TC	$19.50	$36.31	$64.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $107.15	Professional		$72.44	$72.44	$107.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $31.62 / $46.77	Professional	26	$29.51	$31.62	$46.77
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $70.79 / $120.23	Professional		$52.48	$70.79	$120.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $43.65 / $75.86	Professional	26	$33.88	$43.65	$75.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $25.70 / $45.71	Professional	TC	$18.62	$25.70	$45.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.59 / $35.48 / $50.12	Facility	26	$7.59	$35.48	$50.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $79.43 / $138.04	Professional		$54.95	$79.43	$138.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $44.67 / $79.43	Professional	26	$30.20	$44.67	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $38.02 / $70.79	Professional	TC	$22.39	$38.02	$70.79
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $7.59 / $35.48 / $50.12	Facility	26	$7.59	$35.48	$50.12
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $77.62 / $128.82	Professional		$50.12	$77.62	$128.82
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $44.67 / $69.18	Professional	26	$30.20	$44.67	$69.18
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $35.48 / $67.61	Professional	TC	$22.39	$35.48	$67.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $37.15	Professional		$32.36	$33.11	$37.15
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Facility	26	$45.71	$45.71	$45.71
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $77.62 / $138.04	Professional		$66.07	$77.62	$138.04
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $37.15 / $69.18	Professional	26	$31.62	$37.15	$69.18
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $66.07	Professional	TC	$28.18	$40.74	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $66.07 / $120.23	Professional		$45.71	$66.07	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $37.15 / $64.57	Professional	26	$26.30	$37.15	$64.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $27.54 / $53.70	Professional	TC	$17.38	$27.54	$53.70