Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $114.82 / $165.96	Facility	26	$87.10	$114.82	$165.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $389.05 / $1,071.52	Professional		$251.19	$389.05	$1,071.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $93.33 / $302.00	Professional	26	$77.62	$93.33	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $251.19 / $588.84	Professional	TC	$162.18	$251.19	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $229.09 / $363.08	Professional		$177.83	$229.09	$363.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $151.36	Professional	26	$64.57	$83.18	$151.36
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $158.49 / $218.78	Professional	TC	$158.49	$158.49	$218.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $602.56	Professional		$251.19	$346.74	$602.56
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $100.00 / $186.21	Professional	26	$67.61	$100.00	$186.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $245.47 / $407.38	Professional	TC	$190.55	$245.47	$407.38
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $338.84 / $524.81	Professional		$302.00	$338.84	$524.81
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $107.15 / $165.96	Professional	26	$95.50	$107.15	$165.96
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $234.42 / $363.08	Professional	TC	$208.93	$234.42	$363.08
CareSource Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $223.87 / $407.38	Professional		$89.13	$223.87	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $426.58 / $851.14	Professional		$257.04	$426.58	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $204.17	Professional	26	$74.13	$114.82	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $302.00 / $630.96	Professional	TC	$186.21	$302.00	$630.96
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $141.25	Facility	26	$20.89	$97.72	$141.25
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $389.05 / $851.14	Professional		$199.53	$389.05	$851.14
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $120.23 / $251.19	Professional	26	$74.13	$120.23	$251.19
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $295.12 / $676.08	Professional	TC	$186.21	$295.12	$676.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $177.83	Professional		$32.36	$33.11	$177.83
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 $177.83 / $281.84 / $512.86	Professional		$177.83	$281.84	$512.86
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $109.65 / $181.97	Professional	26	$81.28	$109.65	$181.97
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $151.36 / $354.81	Professional	TC	$95.50	$151.36	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $371.54 / $660.69	Professional		$263.03	$371.54	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $100.00 / $173.78	Professional	26	$74.13	$100.00	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $251.19 / $489.78	Professional	TC	$177.83	$251.19	$489.78