Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $91.20 / $134.90	Facility	26	$72.44	$91.20	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $389.05 / $1,288.25	Professional		$204.17	$389.05	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $102.33 / $275.42	Professional	26	$66.07	$102.33	$275.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.72 / $154.88 / $512.86	Professional	52	$97.72	$154.88	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $257.04 / $616.60	Professional	TC	$128.82	$257.04	$616.60
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $165.96 / $323.59	Professional		$141.25	$165.96	$323.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $123.03	Professional	26	$52.48	$69.18	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $194.98 / $194.98	Professional	TC	$194.98	$194.98	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $446.68 / $691.83	Professional		$257.04	$446.68	$691.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $97.72 / $154.88	Professional	26	$74.13	$97.72	$154.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $323.59 / $562.34	Professional	TC	$165.96	$323.59	$562.34
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $223.87 / $371.54	Professional		$213.80	$223.87	$371.54
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $81.28 / $134.90	Professional	26	$77.62	$81.28	$134.90
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $144.54 / $234.42	Professional	TC	$134.90	$144.54	$234.42
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $154.88 / $269.15	Professional		$72.44	$154.88	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Facility Modifier 53 Low / Median / High Price $22.91 / $40.74 / $61.66	Facility	53	$22.91	$40.74	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $389.05 / $776.25	Professional		$199.53	$389.05	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $95.50 / $162.18	Professional	26	$61.66	$95.50	$162.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $223.87 / $660.69	Professional	TC	$123.03	$223.87	$660.69
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Medical Mutual of Ohio Facility/Professional Facility Modifier 53 Low / Median / High Price $22.91 / $38.90 / $61.66	Facility	53	$22.91	$38.90	$61.66
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $338.84 / $794.33	Professional		$169.82	$338.84	$794.33
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $97.72 / $199.53	Professional	26	$63.10	$97.72	$199.53
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $61.66 / $61.66 / $61.66	Professional	52	$61.66	$61.66	$61.66
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $223.87 / $676.08	Professional	TC	$120.23	$223.87	$676.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $138.04	Professional		$32.36	$33.11	$138.04
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $109.65 / $295.12	Facility	26	$109.65	$109.65	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $389.05	Professional		$128.82	$204.17	$389.05
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $87.10 / $147.91	Professional	26	$66.07	$87.10	$147.91
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $97.72 / $295.12	Professional	TC	$61.66	$97.72	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $269.15 / $588.84	Professional		$186.21	$269.15	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $144.54	Professional	26	$58.88	$77.62	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $173.78 / $501.19	Professional	TC	$120.23	$173.78	$501.19