Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $81.28 / $117.49	Facility	26	$61.66	$81.28	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $257.04 / $707.95	Professional		$158.49	$257.04	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $100.00 / $213.80	Professional	26	$57.54	$100.00	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $154.88 / $371.54	Professional	TC	$97.72	$154.88	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $131.83 / $263.03	Professional		$104.71	$131.83	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $102.33	Professional	26	$50.12	$70.79	$102.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $478.63	Professional		$204.17	$295.12	$478.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $83.18 / $134.90	Professional	26	$63.10	$83.18	$134.90
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $204.17 / $346.74	Professional	TC	$120.23	$204.17	$346.74
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $302.00	Professional		$173.78	$269.15	$302.00
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $104.71 / $117.49	Professional	26	$67.61	$104.71	$117.49
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $165.96 / $181.97	Professional	TC	$104.71	$165.96	$181.97
CareSource Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $120.23 / $218.78	Professional		$63.10	$120.23	$218.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $501.19	Professional		$162.18	$275.42	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $141.25	Professional	26	$52.48	$81.28	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $173.78 / $363.08	Professional	TC	$100.00	$173.78	$363.08
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $100.00	Facility	26	$14.79	$69.18	$100.00
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $251.19 / $512.86	Professional		$147.91	$251.19	$512.86
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $162.18	Professional	26	$54.95	$81.28	$162.18
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $173.78 / $407.38	Professional	TC	$97.72	$173.78	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $109.65	Professional		$32.36	$33.11	$109.65
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $95.50 / $128.82	Facility	26	$95.50	$95.50	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $309.03	Professional		$104.71	$138.04	$309.03
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $75.86 / $128.82	Professional	26	$57.54	$75.86	$128.82
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $61.66 / $186.21	Professional	TC	$47.86	$61.66	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $229.09 / $398.11	Professional		$162.18	$229.09	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $123.03	Professional	26	$51.29	$67.61	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $162.18 / $295.12	Professional	TC	$107.15	$162.18	$295.12