Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $79.43 / $186.21	Facility	26	$60.26	$79.43	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $724.44	Professional		$194.98	$281.84	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $89.13 / $213.80	Professional	26	$54.95	$89.13	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $213.80 / $524.81	Professional	TC	$134.90	$213.80	$524.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $147.91 / $177.83	Professional		$64.57	$147.91	$177.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $107.15	Professional	26	$47.86	$58.88	$107.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	TC	$93.33	$93.33	$93.33
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $323.59 / $524.81	Professional		$257.04	$323.59	$524.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $89.13 / $141.25	Professional	26	$69.18	$89.13	$141.25
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $229.09 / $389.05	Professional	TC	$173.78	$229.09	$389.05
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $223.87	Professional		$213.80	$213.80	$223.87
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $69.18	Professional	26	$66.07	$66.07	$69.18
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $147.91 / $154.88	Professional	TC	$147.91	$147.91	$154.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $154.88 / $269.15	Professional		$61.66	$154.88	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $323.59 / $645.65	Professional		$190.55	$323.59	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $144.54	Professional	26	$51.29	$83.18	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $234.42 / $512.86	Professional	TC	$138.04	$234.42	$512.86
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $309.03 / $691.83	Professional		$186.21	$309.03	$691.83
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $154.88	Professional	26	$54.95	$81.28	$154.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $223.87 / $524.81	Professional	TC	$131.83	$223.87	$524.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $144.54	Professional		$32.36	$33.11	$144.54
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 $123.03 / $186.21 / $363.08	Professional		$123.03	$186.21	$363.08
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $72.44 / $123.03	Professional	26	$56.23	$72.44	$123.03
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $100.00 / $245.47	Professional	TC	$66.07	$100.00	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $524.81	Professional		$190.55	$281.84	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $70.79 / $131.83	Professional	26	$54.95	$70.79	$131.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $380.19	Professional	TC	$131.83	$194.98	$380.19