Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $75.86 / $204.17	Facility	26	$56.23	$75.86	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $269.15 / $933.25	Professional		$158.49	$269.15	$933.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $213.80	Professional	26	$51.29	$70.79	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $181.97 / $478.63	Professional	TC	$112.20	$181.97	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $138.04 / $275.42	Professional		$61.66	$138.04	$275.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $52.48 / $93.33	Professional	26	$40.74	$52.48	$93.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $70.79 / $208.93	Professional	TC	$60.26	$70.79	$208.93
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $316.23 / $512.86	Professional		$229.09	$316.23	$512.86
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $128.82	Professional	26	$63.10	$81.28	$128.82
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $229.09 / $380.19	Professional	TC	$147.91	$229.09	$380.19
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $204.17 / $316.23	Professional		$181.97	$204.17	$316.23
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $67.61 / $107.15	Professional	26	$61.66	$67.61	$107.15
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $134.90 / $208.93	Professional	TC	$120.23	$134.90	$208.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $125.89 / $229.09	Professional		$57.54	$125.89	$229.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $63.10 / $89.13	Facility	26	$13.49	$63.10	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $537.03	Professional		$162.18	$275.42	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $75.86 / $134.90	Professional	26	$47.86	$75.86	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $194.98 / $407.38	Professional	TC	$112.20	$194.98	$407.38
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $63.10 / $89.13	Facility	26	$13.49	$63.10	$89.13
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $245.47 / $524.81	Professional		$125.89	$245.47	$524.81
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $79.43 / $162.18	Professional	26	$47.86	$79.43	$162.18
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $186.21 / $416.87	Professional	TC	$107.15	$186.21	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $114.82	Professional		$32.36	$33.11	$114.82
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 $107.15 / $177.83 / $309.03	Professional		$107.15	$177.83	$309.03
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $79.43 / $117.49	Professional	26	$52.48	$79.43	$117.49
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $102.33 / $190.55	Professional	TC	$53.70	$102.33	$190.55
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $239.88 / $436.52	Professional		$158.49	$239.88	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $64.57 / $120.23	Professional	26	$48.98	$64.57	$120.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $158.49 / $309.03	Professional	TC	$107.15	$158.49	$309.03