Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.02 / $58.66 / $141.11	Facility	26	$41.02	$58.66	$141.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.31 / $205.30 / $455.29	Professional		$128.31	$205.30	$455.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $54.55 / $162.91	Professional	26	$40.11	$54.55	$162.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $61.94 / $65.47 / $118.45	Professional	52	$61.94	$65.47	$118.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.29 / $140.10 / $292.77	Professional	TC	$87.29	$140.10	$292.77
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.59 / $96.87 / $117.75	Professional		$67.59	$96.87	$117.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.47 / $43.17 / $66.95	Professional	26	$30.47	$43.17	$66.95
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.85 / $235.85 / $434.63	Professional		$169.85	$235.85	$434.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.90 / $61.51 / $111.81	Professional	26	$48.90	$61.51	$111.81
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $118.96 / $177.56 / $316.05	Professional	TC	$118.96	$177.56	$316.05
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $138.72 / $152.84 / $215.15	Professional		$138.72	$152.84	$215.15
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $45.15 / $49.74 / $70.02	Professional	26	$45.15	$49.74	$70.02
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $93.59 / $103.10 / $145.13	Professional	TC	$93.59	$103.10	$145.13
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.09 / $100.10 / $167.96	Professional		$42.09	$100.10	$167.96
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.97 / $46.27 / $46.27	Facility	26	$41.97	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.05 / $210.81 / $403.56	Professional		$124.05	$210.81	$403.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.75 / $59.73 / $106.90	Professional	26	$37.75	$59.73	$106.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.86 / $146.22 / $291.25	Professional	TC	$83.86	$146.22	$291.25
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $41.97 / $41.97 / $46.27	Facility	26	$41.97	$41.97	$46.27
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $117.57 / $207.20 / $401.28	Professional		$117.57	$207.20	$401.28
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $40.54 / $67.90 / $128.03	Professional	26	$40.54	$67.90	$128.03
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $35.83 / $35.83 / $35.83	Professional	52	$35.83	$35.83	$35.83
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $83.86 / $133.97 / $278.57	Professional	TC	$83.86	$133.97	$278.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.44 / $115.99 / $179.83	Professional		$40.44	$115.99	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $125.35 / $180.42 / $329.28	Professional		$125.35	$180.42	$329.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.54 / $51.65 / $90.13	Professional	26	$37.54	$51.65	$90.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.13 / $113.55 / $229.63	Professional	TC	$83.13	$113.55	$229.63