Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.90 / $68.50 / $165.44	Facility	26	$47.90	$68.50	$165.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.41 / $195.61 / $414.36	Professional		$130.41	$195.61	$414.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.49 / $60.40 / $173.63	Professional	26	$44.49	$60.40	$173.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.51 / $119.70 / $314.14	Professional	TC	$82.51	$119.70	$314.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.32 / $103.06 / $125.19	Professional		$98.32	$103.06	$125.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.43 / $57.58 / $81.50	Professional	26	$35.43	$57.58	$81.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.75 / $67.75 / $67.75	Professional	TC	$67.75	$67.75	$67.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $170.43 / $236.87 / $440.46	Professional		$170.43	$236.87	$440.46
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $62.16 / $113.35	Professional	26	$52.46	$62.16	$113.35
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.79 / $177.58 / $328.52	Professional	TC	$101.79	$177.58	$328.52
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $140.97 / $140.97 / $140.97	Professional		$140.97	$140.97	$140.97
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.26 / $52.26 / $52.26	Professional	26	$52.26	$52.26	$52.26
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $88.71 / $88.71 / $88.71	Professional	TC	$88.71	$88.71	$88.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.72 / $97.73 / $165.20	Professional		$48.72	$97.73	$165.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.19 / $54.02 / $54.02	Facility	26	$49.19	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.79 / $229.27 / $438.37	Professional		$125.79	$229.27	$438.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.06 / $64.34 / $109.86	Professional	26	$41.06	$64.34	$109.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.56 / $157.88 / $329.17	Professional	TC	$81.56	$157.88	$329.17
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $49.19 / $49.19 / $54.02	Facility	26	$49.19	$49.19	$54.02
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $125.60 / $218.40 / $474.50	Professional		$125.60	$218.40	$474.50
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $46.51 / $70.13 / $132.34	Professional	26	$46.51	$70.13	$132.34
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $82.70 / $136.66 / $304.17	Professional	TC	$82.70	$136.66	$304.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $115.99 / $179.83	Professional		$40.43	$115.99	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $142.41 / $205.32 / $352.46	Professional		$142.41	$205.32	$352.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.56 / $58.74 / $105.04	Professional	26	$43.56	$58.74	$105.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.93 / $144.79 / $247.24	Professional	TC	$90.93	$144.79	$247.24