Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $63.10 / $93.33	Facility	26	$47.86	$63.10	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $724.44	Professional		$131.83	$223.87	$724.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $54.95 / $177.83	Professional	26	$43.65	$54.95	$177.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $131.83 / $338.84	Professional	TC	$81.28	$131.83	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $107.15 / $239.88	Professional		$87.10	$107.15	$239.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $45.71 / $83.18	Professional	26	$36.31	$45.71	$83.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	TC	$162.18	$162.18	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $288.40 / $446.68	Professional		$177.83	$288.40	$446.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $117.49	Professional	26	$57.54	$74.13	$117.49
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $199.53 / $338.84	Professional	TC	$107.15	$199.53	$338.84
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $158.49 / $245.47	Professional		$141.25	$158.49	$245.47
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $58.88 / $91.20	Professional	26	$52.48	$58.88	$91.20
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $100.00 / $154.88	Professional	TC	$89.13	$100.00	$154.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $102.33 / $177.83	Professional		$48.98	$102.33	$177.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $245.47 / $446.68	Professional		$131.83	$245.47	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $66.07 / $114.82	Professional	26	$40.74	$66.07	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $158.49 / $338.84	Professional	TC	$83.18	$158.49	$338.84
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $218.78 / $457.09	Professional		$112.20	$218.78	$457.09
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $66.07 / $131.83	Professional	26	$40.74	$66.07	$131.83
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $144.54 / $354.81	Professional	TC	$83.18	$144.54	$354.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $151.36 / $281.84	Professional		$89.13	$151.36	$281.84
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $58.88 / $100.00	Professional	26	$45.71	$58.88	$100.00
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $64.57 / $154.88	Professional	TC	$40.74	$64.57	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $194.98 / $354.81	Professional		$128.82	$194.98	$354.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $56.23 / $97.72	Professional	26	$41.69	$56.23	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $128.82 / $245.47	Professional	TC	$85.11	$128.82	$245.47