Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.08 / $78.51 / $204.77	Facility	26	$56.08	$78.51	$204.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.55 / $245.54 / $557.10	Professional		$165.55	$245.54	$557.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.86 / $70.08 / $199.67	Professional	26	$51.86	$70.08	$199.67
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.53 / $177.11 / $450.20	Professional	TC	$111.53	$177.11	$450.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $65.16 / $126.32 / $133.90	Professional		$65.16	$126.32	$133.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $62.23 / $90.76	Professional	26	$40.96	$62.23	$90.76
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $78.62 / $78.62 / $87.30	Professional	TC	$78.62	$78.62	$87.30
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $202.17 / $262.73 / $491.16	Professional		$202.17	$262.73	$491.16
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.35 / $68.81 / $123.98	Professional	26	$61.35	$68.81	$123.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $137.27 / $195.01 / $376.23	Professional	TC	$137.27	$195.01	$376.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $180.91 / $199.30 / $280.56	Professional		$180.91	$199.30	$280.56
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $61.19 / $67.42 / $94.90	Professional	26	$61.19	$67.42	$94.90
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $119.71 / $131.88 / $185.65	Professional	TC	$119.71	$131.88	$185.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $57.05 / $127.89 / $221.84	Professional		$57.05	$127.89	$221.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.95 / $63.24 / $63.24	Facility	26	$60.95	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.78 / $282.01 / $536.83	Professional		$161.78	$282.01	$536.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.52 / $74.83 / $128.21	Professional	26	$49.52	$74.83	$128.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.31 / $196.53 / $386.80	Professional	TC	$108.31	$196.53	$386.80
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $60.95 / $60.95 / $63.24	Facility	26	$60.95	$60.95	$63.24
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $152.72 / $252.96 / $523.02	Professional		$152.72	$252.96	$523.02
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $56.69 / $88.17 / $173.64	Professional	26	$56.69	$88.17	$173.64
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $111.59 / $179.75 / $372.27	Professional	TC	$111.59	$179.75	$372.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.55 / $127.48 / $219.02	Professional		$40.55	$127.48	$219.02
United Facility/Professional Professional Modifier Low / Median / High Price $173.33 / $239.55 / $454.95	Professional		$173.33	$239.55	$454.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.78 / $70.39 / $131.26	Professional	26	$50.78	$70.39	$131.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.18 / $162.38 / $316.39	Professional	TC	$115.18	$162.38	$316.39