Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.34 / $111.97 / $266.14	Facility	26	$77.34	$111.97	$266.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $220.19 / $287.39 / $658.57	Professional		$220.19	$287.39	$658.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.95 / $80.55 / $183.36	Professional	26	$65.95	$80.55	$183.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.63 / $214.20 / $496.56	Professional	TC	$144.63	$214.20	$496.56
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $153.50 / $167.20 / $186.81	Professional		$153.50	$167.20	$186.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.64 / $64.56 / $100.56	Professional	26	$56.64	$64.56	$100.56
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $112.79 / $112.79 / $112.79	Professional	TC	$112.79	$112.79	$112.79
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $262.14 / $298.08 / $510.58	Professional		$262.14	$298.08	$510.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.14 / $83.60 / $145.07	Professional	26	$72.14	$83.60	$145.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.07 / $216.49 / $376.23	Professional	TC	$162.07	$216.49	$376.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $239.59 / $239.59 / $239.59	Professional		$239.59	$239.59	$239.59
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $84.76 / $84.76 / $84.76	Professional	26	$84.76	$84.76	$84.76
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $154.83 / $154.83 / $154.83	Professional	TC	$154.83	$154.83	$154.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $79.01 / $144.33 / $232.38	Professional		$79.01	$144.33	$232.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.25 / $87.25 / $87.25	Facility	26	$79.25	$87.25	$87.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $214.06 / $338.17 / $657.67	Professional		$214.06	$338.17	$657.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.30 / $99.03 / $162.66	Professional	26	$66.30	$99.03	$162.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $140.13 / $240.61 / $455.80	Professional	TC	$140.13	$240.61	$455.80
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $79.25 / $79.25 / $87.25	Facility	26	$79.25	$79.25	$87.25
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $214.06 / $328.54 / $634.24	Professional		$214.06	$328.54	$634.24
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $71.83 / $100.56 / $167.93	Professional	26	$71.83	$100.56	$167.93
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $142.21 / $223.06 / $454.73	Professional	TC	$142.21	$223.06	$454.73
Molina Facility/Professional Professional Modifier Low / Median / High Price $96.94 / $153.96 / $296.69	Professional		$96.94	$153.96	$296.69
United Facility/Professional Professional Modifier Low / Median / High Price $222.96 / $298.89 / $526.34	Professional		$222.96	$298.89	$526.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.41 / $90.84 / $161.21	Professional	26	$65.41	$90.84	$161.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.66 / $198.35 / $381.18	Professional	TC	$140.66	$198.35	$381.18