Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.59 / $88.07 / $210.58	Facility	26	$61.59	$88.07	$210.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.11 / $210.52 / $424.66	Professional		$151.11	$210.52	$424.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.15 / $66.47 / $183.64	Professional	26	$55.15	$66.47	$183.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.52 / $120.55 / $304.70	Professional	TC	$89.52	$120.55	$304.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.87 / $114.11 / $127.20	Professional		$79.87	$114.11	$127.20
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.81 / $74.44 / $100.21	Professional	26	$45.81	$74.44	$100.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $189.36 / $237.60 / $456.25	Professional		$189.36	$237.60	$456.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.69 / $72.12 / $129.10	Professional	26	$63.69	$72.12	$129.10
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.43 / $171.71 / $317.66	Professional	TC	$110.43	$171.71	$317.66
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $163.58 / $163.58 / $163.58	Professional		$163.58	$163.58	$163.58
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $67.56 / $67.56 / $67.56	Professional	26	$67.56	$67.56	$67.56
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $96.02 / $96.02 / $96.02	Professional	TC	$96.02	$96.02	$96.02
CareSource Facility/Professional Professional Modifier Low / Median / High Price $62.99 / $105.78 / $188.75	Professional		$62.99	$105.78	$188.75
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.72 / $69.44 / $69.44	Facility	26	$62.72	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.56 / $242.07 / $448.03	Professional		$145.56	$242.07	$448.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $81.43 / $137.78	Professional	26	$52.78	$81.43	$137.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.90 / $152.19 / $289.92	Professional	TC	$86.90	$152.19	$289.92
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $62.72 / $62.72 / $69.44	Facility	26	$62.72	$62.72	$69.44
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $145.56 / $235.67 / $438.46	Professional		$145.56	$235.67	$438.46
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $58.58 / $84.17 / $146.54	Professional	26	$58.58	$84.17	$146.54
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $87.27 / $146.51 / $280.14	Professional	TC	$87.27	$146.51	$280.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.55 / $116.44 / $179.83	Professional		$40.55	$116.44	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $143.91 / $196.14 / $364.59	Professional		$143.91	$196.14	$364.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.57 / $75.53 / $142.50	Professional	26	$54.57	$75.53	$142.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.32 / $119.30 / $238.58	Professional	TC	$86.32	$119.30	$238.58