Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.36 / $92.90 / $227.93	Facility	26	$66.36	$92.90	$227.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.21 / $276.99 / $543.41	Professional		$185.21	$276.99	$543.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.52 / $86.29 / $213.20	Professional	26	$61.52	$86.29	$213.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $118.85 / $176.65 / $405.51	Professional	TC	$118.85	$176.65	$405.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $71.95 / $143.91 / $194.71	Professional		$71.95	$143.91	$194.71
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.10 / $77.91 / $107.42	Professional	26	$49.10	$77.91	$107.42
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $92.85 / $92.85 / $92.85	Professional	TC	$92.85	$92.85	$92.85
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $220.58 / $270.17 / $504.01	Professional		$220.58	$270.17	$504.01
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.64 / $77.47 / $138.68	Professional	26	$68.64	$77.47	$138.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $140.09 / $193.80 / $376.23	Professional	TC	$140.09	$193.80	$376.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $199.79 / $199.79 / $199.79	Professional		$199.79	$199.79	$199.79
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $72.43 / $72.43 / $72.43	Professional	26	$72.43	$72.43	$72.43
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $127.36 / $127.36 / $127.36	Professional	TC	$127.36	$127.36	$127.36
CareSource Facility/Professional Professional Modifier Low / Median / High Price $67.52 / $140.31 / $237.33	Professional		$67.52	$140.31	$237.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.81 / $74.84 / $74.84	Facility	26	$67.81	$74.84	$74.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $178.46 / $286.37 / $544.69	Professional		$178.46	$286.37	$544.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.89 / $87.77 / $148.61	Professional	26	$56.89	$87.77	$148.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.23 / $198.04 / $372.99	Professional	TC	$115.23	$198.04	$372.99
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $67.81 / $67.81 / $74.84	Facility	26	$67.81	$67.81	$74.84
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $178.46 / $279.36 / $510.55	Professional		$178.46	$279.36	$510.55
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $64.67 / $96.40 / $185.98	Professional	26	$64.67	$96.40	$185.98
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $116.14 / $183.56 / $368.02	Professional	TC	$116.14	$183.56	$368.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.67 / $135.29 / $218.88	Professional		$65.67	$135.29	$218.88
United Facility/Professional Professional Modifier Low / Median / High Price $183.16 / $247.75 / $446.82	Professional		$183.16	$247.75	$446.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.18 / $78.38 / $141.58	Professional	26	$58.18	$78.38	$141.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.55 / $158.76 / $304.45	Professional	TC	$119.55	$158.76	$304.45