Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.12 / $83.24 / $197.85	Facility	26	$59.12	$83.24	$197.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $222.03 / $380.78 / $663.75	Professional		$222.03	$380.78	$663.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.12 / $103.26 / $184.72	Professional	26	$59.12	$103.26	$184.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.90 / $279.37 / $560.49	Professional	TC	$162.90	$279.37	$560.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $127.24 / $162.52 / $172.23	Professional		$127.24	$162.52	$172.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.99 / $55.28 / $74.42	Professional	26	$41.99	$55.28	$74.42
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $256.20 / $362.98 / $691.20	Professional		$256.20	$362.98	$691.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.41 / $67.98 / $125.07	Professional	26	$57.41	$67.98	$125.07
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $196.40 / $291.24 / $541.50	Professional	TC	$196.40	$291.24	$541.50
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $232.55 / $232.55 / $256.20	Professional		$232.55	$232.55	$256.20
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $62.73 / $62.73 / $69.11	Professional	26	$62.73	$62.73	$69.11
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $169.83 / $169.83 / $187.10	Professional	TC	$169.83	$169.83	$187.10
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.48 / $181.39 / $284.24	Professional		$58.48	$181.39	$284.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.86 / $64.84 / $64.84	Facility	26	$58.86	$64.84	$64.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $209.32 / $417.67 / $826.23	Professional		$209.32	$417.67	$826.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.28 / $76.70 / $131.60	Professional	26	$49.28	$76.70	$131.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $156.47 / $322.38 / $720.50	Professional	TC	$156.47	$322.38	$720.50
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $58.86 / $58.86 / $64.84	Facility	26	$58.86	$58.86	$64.84
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $197.13 / $395.82 / $820.70	Professional		$197.13	$395.82	$820.70
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $55.82 / $83.18 / $153.44	Professional	26	$55.82	$83.18	$153.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $158.31 / $286.04 / $698.71	Professional	TC	$158.31	$286.04	$698.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.46 / $183.60 / $277.73	Professional		$40.46	$183.60	$277.73
United Facility/Professional Professional Modifier Low / Median / High Price $224.12 / $341.86 / $697.98	Professional		$224.12	$341.86	$697.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.27 / $67.70 / $123.18	Professional	26	$51.27	$67.70	$123.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $164.08 / $243.97 / $556.45	Professional	TC	$164.08	$243.97	$556.45