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 $194.98 / $398.11 / $1,230.27	Professional		$194.98	$398.11	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $125.89 / $316.23	Professional	26	$66.07	$125.89	$316.23
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 $70.79 / $154.88 / $316.23	Professional		$70.79	$154.88	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $69.18 / $117.49	Professional	26	$52.48	$69.18	$117.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $141.25 / $186.21	Professional	TC	$95.50	$141.25	$186.21
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 / $102.33 / $165.96	Professional	26	$79.43	$102.33	$165.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $323.59 / $575.44	Professional	TC	$162.18	$323.59	$575.44
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $234.42 / $323.59	Professional		$208.93	$234.42	$323.59
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $87.10 / $123.03	Professional	26	$77.62	$87.10	$123.03
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $144.54 / $204.17	Professional	TC	$128.82	$144.54	$204.17
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 / $371.54 / $831.76	Professional		$194.98	$371.54	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $97.72 / $165.96	Professional	26	$61.66	$97.72	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $213.80 / $630.96	Professional	TC	$117.49	$213.80	$630.96
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 $165.96 / $323.59 / $851.14	Professional		$165.96	$323.59	$851.14
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $104.71 / $204.17	Professional	26	$64.57	$104.71	$204.17
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $213.80 / $630.96	Professional	TC	$114.82	$213.80	$630.96
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 $125.89 / $190.55 / $371.54	Professional		$125.89	$190.55	$371.54
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 / $89.13 / $263.03	Professional	TC	$58.88	$89.13	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $263.03 / $588.84	Professional		$181.97	$263.03	$588.84
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 / $165.96 / $467.74	Professional	TC	$114.82	$165.96	$467.74