Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $138.04 / $199.53	Facility	26	$107.15	$138.04	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $537.03 / $1,862.09	Professional		$346.74	$537.03	$1,862.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $181.97 / $478.63	Professional	26	$97.72	$181.97	$478.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $371.54 / $1,096.48	Professional	TC	$245.47	$371.54	$1,096.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $275.42 / $575.44	Professional		$229.09	$275.42	$575.44
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $117.49 / $169.82	Professional	26	$95.50	$117.49	$169.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $489.78 / $794.33	Professional		$363.08	$489.78	$794.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $120.23 / $213.80	Professional	26	$87.10	$120.23	$213.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $363.08 / $588.84	Professional	TC	$281.84	$363.08	$588.84
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $407.38 / $575.44	Professional		$363.08	$407.38	$575.44
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $125.89 / $177.83	Professional	26	$114.82	$125.89	$177.83
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $281.84 / $398.11	Professional	TC	$251.19	$281.84	$398.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $269.15 / $489.78	Professional		$104.71	$269.15	$489.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $588.84 / $1,318.26	Professional		$323.59	$588.84	$1,318.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $229.09	Professional	26	$89.13	$138.04	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $426.58 / $1,122.02	Professional	TC	$234.42	$426.58	$1,122.02
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $575.44 / $1,412.54	Professional		$309.03	$575.44	$1,412.54
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $141.25 / $281.84	Professional	26	$91.20	$141.25	$281.84
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $407.38 / $1,096.48	Professional	TC	$223.87	$407.38	$1,096.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $269.15	Professional		$32.36	$33.11	$269.15
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $363.08 / $724.44	Professional		$218.78	$363.08	$724.44
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $120.23 / $213.80	Professional	26	$95.50	$120.23	$213.80
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $446.68	Professional	TC	$114.82	$173.78	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $478.63 / $1,023.29	Professional		$323.59	$478.63	$1,023.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $204.17	Professional	26	$85.11	$112.20	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $338.84 / $851.14	Professional	TC	$229.09	$338.84	$851.14