Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $95.50 / $134.90	Facility	26	$72.44	$95.50	$134.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $426.58 / $1,258.93	Professional		$199.53	$426.58	$1,258.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $125.89 / $309.03	Professional	26	$67.61	$125.89	$309.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $158.49 / $512.86 / $549.54	Professional	52	$158.49	$512.86	$549.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $251.19 / $645.65	Professional	TC	$123.03	$251.19	$645.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $151.36 / $302.00	Professional		$128.82	$151.36	$302.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $123.03	Professional	26	$52.48	$64.57	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $107.15 / $194.98	Professional	TC	$89.13	$107.15	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $446.68 / $707.95	Professional		$257.04	$446.68	$707.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $104.71 / $165.96	Professional	26	$79.43	$104.71	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $323.59 / $562.34	Professional	TC	$162.18	$323.59	$562.34
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $234.42 / $363.08	Professional		$208.93	$234.42	$363.08
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $87.10 / $134.90	Professional	26	$77.62	$87.10	$134.90
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $144.54 / $223.87	Professional	TC	$128.82	$144.54	$223.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $147.91 / $263.03	Professional		$72.44	$147.91	$263.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $363.08 / $776.25	Professional		$194.98	$363.08	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $95.50 / $165.96	Professional	26	$61.66	$95.50	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $208.93 / $602.56	Professional	TC	$117.49	$208.93	$602.56
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $323.59 / $758.58	Professional		$151.36	$323.59	$758.58
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $102.33 / $204.17	Professional	26	$61.66	$102.33	$204.17
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $218.78 / $660.69	Professional	TC	$114.82	$218.78	$660.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $131.83	Professional		$32.36	$33.11	$131.83
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $162.18 / $331.13	Professional		$128.82	$162.18	$331.13
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $147.91	Professional	26	$66.07	$100.00	$147.91
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $112.20 / $229.09	Professional	TC	$58.88	$112.20	$229.09
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $263.03 / $562.34	Professional		$181.97	$263.03	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $144.54	Professional	26	$60.26	$81.28	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $169.82 / $457.09	Professional	TC	$114.82	$169.82	$457.09