Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.54 / $103.18 / $245.25	Facility	26	$73.54	$103.18	$245.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $198.40 / $370.50 / $884.45	Professional		$198.40	$370.50	$884.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.68 / $123.51 / $244.95	Professional	26	$70.68	$123.51	$244.95
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $98.96 / $122.86 / $262.50	Professional	52	$98.96	$122.86	$262.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.87 / $236.39 / $557.00	Professional	TC	$124.87	$236.39	$557.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.96 / $149.69 / $153.43	Professional		$126.96	$149.69	$153.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.90 / $78.09 / $115.71	Professional	26	$52.90	$78.09	$115.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.47 / $91.21 / $198.16	Professional	TC	$79.47	$91.21	$198.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $250.39 / $361.64 / $664.00	Professional		$250.39	$361.64	$664.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.23 / $83.68 / $149.80	Professional	26	$74.23	$83.68	$149.80
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $149.72 / $285.00 / $537.47	Professional	TC	$149.72	$285.00	$537.47
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $207.82 / $228.96 / $322.30	Professional		$207.82	$228.96	$322.30
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $78.02 / $85.96 / $121.00	Professional	26	$78.02	$85.96	$121.00
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $129.79 / $142.99 / $201.28	Professional	TC	$129.79	$142.99	$201.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $72.73 / $142.99 / $241.85	Professional		$72.73	$142.99	$241.85
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.90 / $80.59 / $80.59	Facility	26	$72.90	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.68 / $325.29 / $735.06	Professional		$185.68	$325.29	$735.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.27 / $95.06 / $159.80	Professional	26	$61.27	$95.06	$159.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.44 / $208.95 / $611.04	Professional	TC	$117.44	$208.95	$611.04
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $72.90 / $72.90 / $80.59	Facility	26	$72.90	$72.90	$80.59
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $176.12 / $324.80 / $700.00	Professional		$176.12	$324.80	$700.00
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $69.43 / $105.80 / $203.14	Professional	26	$69.43	$105.80	$203.14
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $120.99 / $205.36 / $592.27	Professional	TC	$120.99	$205.36	$592.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.67 / $135.29 / $218.39	Professional		$65.67	$135.29	$218.39
United Facility/Professional Professional Modifier Low / Median / High Price $192.16 / $266.08 / $581.15	Professional		$192.16	$266.08	$581.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.56 / $82.06 / $149.58	Professional	26	$63.56	$82.06	$149.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.85 / $170.22 / $448.71	Professional	TC	$125.85	$170.22	$448.71