Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $54.95 / $141.25	Facility	26	$40.74	$54.95	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $676.08	Professional		$107.15	$181.97	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $44.67 / $138.04	Professional	26	$37.15	$44.67	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $114.82 / $323.59	Professional	TC	$64.57	$114.82	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $97.72 / $194.98	Professional		$85.11	$97.72	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $39.81 / $70.79	Professional	26	$30.20	$39.81	$70.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $83.18 / $85.11	Professional	TC	$57.54	$83.18	$85.11
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $223.87 / $363.08	Professional		$138.04	$223.87	$363.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $56.23 / $89.13	Professional	26	$42.66	$56.23	$89.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $158.49 / $275.42	Professional	TC	$79.43	$158.49	$275.42
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $128.82 / $199.53	Professional		$114.82	$128.82	$199.53
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $50.12 / $77.62	Professional	26	$44.67	$50.12	$77.62
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $79.43 / $123.03	Professional	TC	$70.79	$79.43	$123.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $81.28 / $147.91	Professional		$41.69	$81.28	$147.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $66.07	Facility	26	$9.77	$45.71	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $169.82 / $346.74	Professional		$102.33	$169.82	$346.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $54.95 / $95.50	Professional	26	$34.67	$54.95	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $109.65 / $251.19	Professional	TC	$63.10	$109.65	$251.19
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $66.07	Facility	26	$9.77	$45.71	$66.07
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $158.49 / $346.74	Professional		$74.13	$158.49	$346.74
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $57.54 / $112.20	Professional	26	$34.67	$57.54	$112.20
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $109.65 / $257.04	Professional	TC	$63.10	$109.65	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $66.07	Professional		$32.36	$33.11	$66.07
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $112.20 / $190.55	Professional		$70.79	$112.20	$190.55
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $50.12 / $85.11	Professional	26	$38.02	$50.12	$85.11
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $61.66 / $114.82	Professional	TC	$32.36	$61.66	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $141.25 / $275.42	Professional		$100.00	$141.25	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $44.67 / $83.18	Professional	26	$34.67	$44.67	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $87.10 / $190.55	Professional	TC	$60.26	$87.10	$190.55