Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $28.84 / $40.74	Facility	26	$21.38	$28.84	$40.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $40.74 / $104.71	Professional		$30.90	$40.74	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $28.18 / $83.18	Professional	26	$20.42	$28.18	$83.18
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.72 / $97.72 / $97.72	Professional	52	$97.72	$97.72	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $12.02 / $25.12	Professional	TC	$10.00	$12.02	$25.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $48.98	Professional		$28.18	$33.11	$48.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $22.39 / $28.84	Professional	26	$19.05	$22.39	$28.84
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $8.91 / $8.91 / $10.72	Professional	52	$8.91	$8.91	$10.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $37.15 / $60.26	Professional		$29.51	$37.15	$60.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $25.70 / $40.74	Professional	26	$20.42	$25.70	$40.74
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $10.00 / $12.59 / $19.95	Professional	TC	$10.00	$12.59	$19.95
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $31.62 / $70.79	Professional		$31.62	$31.62	$70.79
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $20.42 / $44.67	Professional	26	$20.42	$20.42	$44.67
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $11.22 / $26.30	Professional	TC	$11.22	$11.22	$26.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $12.88 / $27.54 / $48.98	Professional		$12.88	$27.54	$48.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.37 / $25.12 / $35.48	Facility	26	$5.37	$25.12	$35.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $44.67 / $77.62	Professional		$32.36	$44.67	$77.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $50.12	Professional	26	$21.88	$29.51	$50.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.72 / $15.14 / $25.70	Professional	TC	$10.72	$15.14	$25.70
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $5.37 / $25.12 / $35.48	Facility	26	$5.37	$25.12	$35.48
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $43.65 / $69.18	Professional		$31.62	$43.65	$69.18
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $29.51 / $48.98	Professional	26	$20.89	$29.51	$48.98
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $10.47 / $14.79 / $23.44	Professional	TC	$10.47	$14.79	$23.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.38 / $32.36 / $33.11	Professional		$17.38	$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 $35.48 / $43.65 / $83.18	Professional		$35.48	$43.65	$83.18
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $27.54 / $51.29	Professional	26	$23.44	$27.54	$51.29
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $12.88 / $16.22 / $30.20	Professional	TC	$12.88	$16.22	$30.20
United Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $36.31 / $60.26	Professional		$27.54	$36.31	$60.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $24.55 / $41.69	Professional	26	$18.62	$24.55	$41.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $8.71 / $11.75 / $19.05	Professional	TC	$8.71	$11.75	$19.05