Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.01 / $72.81 / $175.27	Facility	26	$52.01	$72.81	$175.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $157.51 / $262.52	Professional		$134.40	$157.51	$262.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.28 / $61.74 / $110.28	Professional	26	$48.28	$61.74	$110.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.37 / $97.45 / $163.84	Professional	TC	$86.37	$97.45	$163.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $101.48 / $107.69 / $132.74	Professional		$101.48	$107.69	$132.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.97 / $47.02 / $84.18	Professional	26	$37.97	$47.02	$84.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $70.29 / $122.08 / $122.08	Professional	TC	$70.29	$122.08	$122.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.36 / $158.04 / $281.92	Professional		$123.36	$158.04	$281.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.27 / $56.98 / $103.80	Professional	26	$46.27	$56.98	$103.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.09 / $99.97 / $178.11	Professional	TC	$77.09	$99.97	$178.11
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $149.68 / $149.68 / $149.68	Professional		$149.68	$149.68	$149.68
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $56.76 / $56.76 / $56.76	Professional	26	$56.76	$56.76	$56.76
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $92.94 / $92.94 / $92.94	Professional	TC	$92.94	$92.94	$92.94
CareSource Facility/Professional Professional Modifier Low / Median / High Price $52.91 / $102.39 / $173.77	Professional		$52.91	$102.39	$173.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $126.33 / $189.36 / $310.22	Professional		$126.33	$189.36	$310.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.57 / $68.59 / $114.78	Professional	26	$44.57	$68.59	$114.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.76 / $118.72 / $198.08	Professional	TC	$78.76	$118.72	$198.08
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $131.47 / $190.28 / $355.19	Professional		$131.47	$190.28	$355.19
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $48.10 / $73.58 / $140.19	Professional	26	$48.10	$73.58	$140.19
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $82.70 / $116.79 / $193.44	Professional	TC	$82.70	$116.79	$193.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.51 / $115.31 / $179.69	Professional		$40.51	$115.31	$179.69
United Facility/Professional Professional Modifier Low / Median / High Price $126.46 / $170.33 / $303.89	Professional		$126.46	$170.33	$303.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.46 / $61.16 / $106.80	Professional	26	$44.46	$61.16	$106.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.26 / $108.09 / $196.78	Professional	TC	$82.26	$108.09	$196.78