Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $63.10 / $112.20	Facility	26	$38.02	$63.10	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $83.18 / $181.97	Professional		$66.07	$83.18	$181.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $47.86 / $102.33	Professional	26	$33.88	$47.86	$102.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $37.15 / $69.18	Professional	TC	$22.91	$37.15	$69.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $66.07 / $87.10	Professional		$63.10	$66.07	$87.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $44.67	Professional	26	$43.65	$43.65	$44.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $83.18 / $141.25	Professional		$63.10	$83.18	$141.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $53.70 / $91.20	Professional	26	$39.81	$53.70	$91.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $28.84 / $51.29	Professional	TC	$20.89	$28.84	$51.29
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $40.74 / $57.54	Facility	26	$8.71	$40.74	$57.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $91.20 / $147.91	Professional		$63.10	$91.20	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $53.70 / $93.33	Professional	26	$35.48	$53.70	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $38.02 / $70.79	Professional	TC	$23.44	$38.02	$70.79
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $40.74 / $57.54	Facility	26	$8.71	$40.74	$57.54
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $91.20 / $138.04	Professional		$61.66	$91.20	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $52.48 / $89.13	Professional	26	$34.67	$52.48	$89.13
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $37.15 / $67.61	Professional	TC	$22.91	$37.15	$67.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $57.54	Professional		$32.36	$33.11	$57.54
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 $70.79 / $83.18 / $147.91	Professional		$70.79	$83.18	$147.91
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $42.66 / $81.28	Professional	26	$36.31	$42.66	$81.28
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $39.81 / $64.57	Professional	TC	$31.62	$39.81	$64.57
United Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $72.44 / $131.83	Professional		$52.48	$72.44	$131.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $46.77 / $75.86	Professional	26	$31.62	$46.77	$75.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $28.84 / $53.70	Professional	TC	$19.05	$28.84	$53.70