Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.00 / $72.81 / $192.04	Facility	26	$52.00	$72.81	$192.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.33 / $199.76 / $414.36	Professional		$131.33	$199.76	$414.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.33 / $59.38 / $171.84	Professional	26	$47.33	$59.38	$171.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $65.67 / $68.28 / $127.22	Professional	52	$65.67	$68.28	$127.22
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.87 / $130.99 / $306.32	Professional	TC	$81.87	$130.99	$306.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.62 / $104.26 / $128.37	Professional		$92.62	$104.26	$128.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.97 / $48.62 / $84.18	Professional	26	$37.97	$48.62	$84.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $62.66 / $115.61 / $115.61	Professional	TC	$62.66	$115.61	$115.61
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $170.43 / $236.87 / $453.38	Professional		$170.43	$236.87	$453.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.44 / $62.79 / $114.30	Professional	26	$54.44	$62.79	$114.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.00 / $177.58 / $330.00	Professional	TC	$101.00	$177.58	$330.00
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $144.77 / $144.77 / $224.52	Professional		$144.77	$144.77	$224.52
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $56.76 / $56.76 / $88.02	Professional	26	$56.76	$56.76	$88.02
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $88.02 / $88.02 / $136.50	Professional	TC	$88.02	$88.02	$136.50
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.91 / $96.97 / $168.16	Professional		$52.91	$96.97	$168.16
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.09 / $58.64 / $58.64	Facility	26	$57.09	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $232.15 / $438.37	Professional		$128.82	$232.15	$438.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.57 / $68.84 / $114.78	Professional	26	$44.57	$68.84	$114.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.66 / $156.63 / $308.64	Professional	TC	$79.66	$156.63	$308.64
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $57.09 / $57.09 / $58.64	Facility	26	$57.09	$57.09	$58.64
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $122.69 / $216.60 / $418.58	Professional		$122.69	$216.60	$418.58
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $77.28 / $148.61	Professional	26	$50.50	$77.28	$148.61
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $82.05 / $136.35 / $294.20	Professional	TC	$82.05	$136.35	$294.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $115.99 / $179.83	Professional		$40.43	$115.99	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $139.34 / $193.78 / $361.17	Professional		$139.34	$193.78	$361.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.42 / $65.09 / $114.53	Professional	26	$48.42	$65.09	$114.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.68 / $119.95 / $243.41	Professional	TC	$82.68	$119.95	$243.41