Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.67 / $126.80 / $295.04	Facility	26	$88.67	$126.80	$295.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $284.64 / $370.50 / $603.46	Professional		$284.64	$370.50	$603.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $86.42 / $111.15 / $187.98	Professional	26	$86.42	$111.15	$187.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $195.98 / $259.35 / $415.48	Professional	TC	$195.98	$259.35	$415.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.96 / $162.96 / $162.96	Professional		$162.96	$162.96	$162.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $104.48 / $110.95 / $112.52	Professional	26	$104.48	$110.95	$112.52
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $327.84 / $415.72 / $743.31	Professional		$327.84	$415.72	$743.31
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.27 / $104.48 / $189.72	Professional	26	$94.27	$104.48	$189.72
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $222.93 / $298.82 / $564.30	Professional	TC	$222.93	$298.82	$564.30
CareSource Facility/Professional Professional Modifier Low / Median / High Price $88.41 / $189.43 / $277.83	Professional		$88.41	$189.43	$277.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.67 / $97.16 / $97.16	Facility	26	$87.67	$97.16	$97.16
Cigna Facility/Professional Professional Modifier Low / Median / High Price $265.95 / $454.64 / $917.98	Professional		$265.95	$454.64	$917.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.67 / $114.72 / $192.52	Professional	26	$75.67	$114.72	$192.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $183.87 / $322.83 / $713.48	Professional	TC	$183.87	$322.83	$713.48
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $87.67 / $87.67 / $97.16	Facility	26	$87.67	$87.67	$97.16
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $267.52 / $447.14 / $949.25	Professional		$267.52	$447.14	$949.25
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $80.79 / $115.98 / $191.70	Professional	26	$80.79	$115.98	$191.70
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $189.43 / $309.74 / $678.90	Professional	TC	$189.43	$309.74	$678.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $209.00 / $343.84	Professional		$98.87	$209.00	$343.84
United Facility/Professional Professional Modifier Low / Median / High Price $282.94 / $384.51 / $751.15	Professional		$282.94	$384.51	$751.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.97 / $100.84 / $177.39	Professional	26	$74.97	$100.84	$177.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.59 / $251.35 / $528.50	Professional	TC	$195.59	$251.35	$528.50