Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.61 / $65.31 / $114.88	Facility	26	$38.61	$65.31	$114.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.28 / $85.00 / $283.02	Professional		$61.28	$85.00	$283.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.36 / $43.03 / $172.11	Professional	26	$35.36	$43.03	$172.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $41.63 / $72.09	Professional	TC	$22.57	$41.63	$72.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.75 / $92.06 / $151.00	Professional		$65.75	$92.06	$151.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.73 / $40.60 / $51.18	Professional	26	$31.73	$40.60	$51.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.69 / $78.12 / $136.43	Professional		$60.69	$78.12	$136.43
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.54 / $50.00 / $84.15	Professional	26	$38.54	$50.00	$84.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.27 / $27.30 / $51.30	Professional	TC	$20.27	$27.30	$51.30
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $91.91 / $91.91 / $91.91	Professional		$91.91	$91.91	$91.91
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $44.36 / $44.36 / $44.36	Professional	26	$44.36	$44.36	$44.36
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $47.55 / $47.55 / $47.55	Professional	TC	$47.55	$47.55	$47.55
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.58 / $58.53 / $106.07	Professional		$36.58	$58.53	$106.07
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.65 / $41.65 / $41.65	Facility	26	$41.65	$41.65	$41.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.63 / $90.84 / $149.82	Professional		$63.63	$90.84	$149.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.83 / $50.61 / $87.22	Professional	26	$35.83	$50.61	$87.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.14 / $40.97 / $76.14	Professional	TC	$26.14	$40.97	$76.14
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $61.24 / $90.62 / $135.41	Professional		$61.24	$90.62	$135.41
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $34.71 / $50.09 / $78.48	Professional	26	$34.71	$50.09	$78.48
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $26.14 / $40.56 / $71.34	Professional	TC	$26.14	$40.56	$71.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $27.96 / $46.63 / $124.20	Professional		$27.96	$46.63	$124.20
United Facility/Professional Professional Modifier Low / Median / High Price $53.86 / $80.59 / $141.96	Professional		$53.86	$80.59	$141.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.24 / $46.57 / $83.74	Professional	26	$32.24	$46.57	$83.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.14 / $33.56 / $63.34	Professional	TC	$20.14	$33.56	$63.34