Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.62 / $102.33 / $151.36	Facility	26	$77.62	$102.33	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $323.59 / $912.01	Professional		$218.78	$323.59	$912.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $104.71 / $245.47	Professional	26	$64.57	$104.71	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $524.81	Professional	TC	$144.54	$218.78	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $177.83 / $407.38	Professional		$147.91	$177.83	$407.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $70.79 / $131.83	Professional	26	$61.66	$70.79	$131.83
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $112.20 / $177.83	Professional	TC	$97.72	$112.20	$177.83
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $331.13 / $524.81	Professional		$263.03	$331.13	$524.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $95.50 / $151.36	Professional	26	$72.44	$95.50	$151.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $229.09 / $389.05	Professional	TC	$181.97	$229.09	$389.05
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $239.88	Professional		$239.88	$239.88	$239.88
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $85.11 / $85.11	Professional	26	$85.11	$85.11	$85.11
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $154.88	Professional	TC	$154.88	$154.88	$154.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $363.08 / $660.69	Professional		$213.80	$363.08	$660.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $97.72 / $165.96	Professional	26	$64.57	$97.72	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $234.42 / $467.74	Professional	TC	$141.25	$234.42	$467.74
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $323.59 / $660.69	Professional		$204.17	$323.59	$660.69
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $177.83	Professional	26	$66.07	$97.72	$177.83
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $223.87 / $467.74	Professional	TC	$138.04	$223.87	$467.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $162.18	Professional		$32.36	$33.11	$162.18
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $186.21 / $389.05	Professional		$141.25	$186.21	$389.05
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $93.33 / $158.49	Professional	26	$72.44	$93.33	$158.49
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $91.20 / $251.19	Professional	TC	$70.79	$91.20	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $295.12 / $501.19	Professional		$204.17	$295.12	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $83.18 / $147.91	Professional	26	$60.26	$83.18	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $199.53 / $371.54	Professional	TC	$134.90	$199.53	$371.54