Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.08 / $80.61 / $185.16	Facility	26	$54.08	$80.61	$185.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.87 / $194.37 / $522.37	Professional		$152.87	$194.37	$522.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.08 / $69.08 / $202.30	Professional	26	$54.08	$69.08	$202.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.79 / $126.52 / $337.22	Professional	TC	$98.79	$126.52	$337.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $73.33 / $115.33 / $121.03	Professional		$73.33	$115.33	$121.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.65 / $59.48 / $88.03	Professional	26	$39.65	$59.48	$88.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.12 / $258.92 / $492.34	Professional		$194.12	$258.92	$492.34
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.22 / $71.80 / $129.13	Professional	26	$59.22	$71.80	$129.13
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $122.00 / $190.00 / $351.96	Professional	TC	$122.00	$190.00	$351.96
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $165.15 / $165.15 / $165.15	Professional		$165.15	$165.15	$165.15
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $59.35 / $59.35 / $59.35	Professional	26	$59.35	$59.35	$59.35
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $105.80 / $105.80 / $105.80	Professional	TC	$105.80	$105.80	$105.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $55.33 / $116.56 / $197.25	Professional		$55.33	$116.56	$197.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $55.17 / $60.98 / $60.98	Facility	26	$55.17	$60.98	$60.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.28 / $251.22 / $479.23	Professional		$147.28	$251.22	$479.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.87 / $72.94 / $123.96	Professional	26	$48.87	$72.94	$123.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.71 / $165.94 / $345.36	Professional	TC	$95.71	$165.94	$345.36
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $55.17 / $55.17 / $60.98	Facility	26	$55.17	$55.17	$60.98
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $146.96 / $242.52 / $479.23	Professional		$146.96	$242.52	$479.23
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $51.24 / $75.70 / $140.87	Professional	26	$51.24	$75.70	$140.87
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $96.27 / $154.22 / $331.94	Professional	TC	$96.27	$154.22	$331.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.51 / $115.99 / $179.83	Professional		$40.51	$115.99	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $149.69 / $212.85 / $407.58	Professional		$149.69	$212.85	$407.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.44 / $67.00 / $118.87	Professional	26	$51.44	$67.00	$118.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.77 / $137.13 / $277.95	Professional	TC	$95.77	$137.13	$277.95