Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $27.54 / $56.23	Facility	26	$19.05	$27.54	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $74.13 / $288.40	Professional		$53.70	$74.13	$288.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $22.91 / $77.62	Professional	26	$16.98	$22.91	$77.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $28.84 / $28.84 / $263.03	Professional	50	$28.84	$28.84	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $43.65 / $75.86	Professional	TC	$37.15	$43.65	$75.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $60.26 / $102.33	Professional		$52.48	$60.26	$102.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $20.89 / $32.36	Professional	26	$17.78	$20.89	$32.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $66.07 / $107.15	Professional		$50.12	$66.07	$107.15
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $20.89 / $33.88	Professional	26	$15.49	$20.89	$33.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $45.71 / $74.13	Professional	TC	$33.11	$45.71	$74.13
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $109.65	Professional		$109.65	$109.65	$109.65
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $32.36 / $32.36	Professional	26	$32.36	$32.36	$32.36
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $77.62 / $77.62	Professional	TC	$77.62	$77.62	$77.62
CareSource Facility/Professional Professional Modifier Low / Median / High Price $19.95 / $45.71 / $75.86	Professional		$19.95	$45.71	$75.86
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $20.42 / $29.51	Facility	26	$4.37	$20.42	$29.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $77.62 / $141.25	Professional		$53.70	$77.62	$141.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $24.55 / $43.65	Professional	26	$16.98	$24.55	$43.65
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $52.48 / $95.50	Professional	TC	$37.15	$52.48	$95.50
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $4.37 / $20.42 / $29.51	Facility	26	$4.37	$20.42	$29.51
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $75.86 / $123.03	Professional		$52.48	$75.86	$123.03
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $14.79 / $24.55 / $47.86	Professional	26	$14.79	$24.55	$47.86
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $51.29 / $87.10	Professional	TC	$36.31	$51.29	$87.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.13 / $32.36 / $33.11	Professional		$14.13	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $72.44 / $138.04	Professional		$58.88	$72.44	$138.04
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $18.62 / $21.88 / $41.69	Professional	26	$18.62	$21.88	$41.69
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $97.72	Professional	TC	$38.90	$48.98	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $69.18 / $117.49	Professional		$50.12	$69.18	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $21.88 / $37.15	Professional	26	$15.85	$21.88	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $47.86 / $81.28	Professional	TC	$33.88	$47.86	$81.28