Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.36 / $73.30 / $179.32	Facility	26	$52.36	$73.30	$179.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.91 / $199.55 / $409.07	Professional		$133.91	$199.55	$409.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $55.17 / $147.06	Professional	26	$48.61	$55.17	$147.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.56 / $119.70 / $285.50	Professional	TC	$81.56	$119.70	$285.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.72 / $101.03 / $222.12	Professional		$78.72	$101.03	$222.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.24 / $50.36 / $80.26	Professional	26	$38.24	$50.36	$80.26
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $61.62 / $61.62 / $61.62	Professional	TC	$61.62	$61.62	$61.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $159.29 / $226.22 / $433.49	Professional		$159.29	$226.22	$433.49
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.24 / $61.43 / $109.97	Professional	26	$54.24	$61.43	$109.97
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $96.23 / $170.37 / $314.16	Professional	TC	$96.23	$170.37	$314.16
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $144.81 / $144.81 / $144.81	Professional		$144.81	$144.81	$144.81
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $57.14 / $57.14 / $57.14	Professional	26	$57.14	$57.14	$57.14
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $87.67 / $87.67 / $87.67	Professional	TC	$87.67	$87.67	$87.67
CareSource Facility/Professional Professional Modifier Low / Median / High Price $53.26 / $96.59 / $168.21	Professional		$53.26	$96.59	$168.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.41 / $59.04 / $59.04	Facility	26	$53.41	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.85 / $209.22 / $418.68	Professional		$128.85	$209.22	$418.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.87 / $69.65 / $116.70	Professional	26	$44.87	$69.65	$116.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $78.54 / $134.60 / $290.30	Professional	TC	$78.54	$134.60	$290.30
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $53.41 / $53.41 / $59.04	Facility	26	$53.41	$53.41	$59.04
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $128.72 / $202.49 / $419.66	Professional		$128.72	$202.49	$419.66
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $49.09 / $72.63 / $135.58	Professional	26	$49.09	$72.63	$135.58
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $79.20 / $126.01 / $281.24	Professional	TC	$79.20	$126.01	$281.24
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.55 / $115.99 / $179.83	Professional		$40.55	$115.99	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $130.63 / $180.67 / $339.74	Professional		$130.63	$180.67	$339.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.58 / $61.14 / $111.16	Professional	26	$40.58	$61.14	$111.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.34 / $108.09 / $221.36	Professional	TC	$78.34	$108.09	$221.36