Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $64.57 / $93.33	Facility	26	$47.86	$64.57	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $165.96 / $457.09	Professional		$58.88	$165.96	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $79.43 / $194.98	Professional	26	$45.71	$79.43	$194.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.65 / $199.53 / $354.81	Professional	50	$43.65	$199.53	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $154.88 / $346.74	Professional	TC	$100.00	$154.88	$346.74
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $131.83 / $151.36	Professional		$104.71	$131.83	$151.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $85.11	Professional	26	$35.48	$45.71	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $134.90 / $162.18	Professional	TC	$83.18	$134.90	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $275.42 / $436.52	Professional		$194.98	$275.42	$436.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $69.18 / $112.20	Professional	26	$53.70	$69.18	$112.20
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $288.40 / $416.87 / $660.69	Professional	50	$288.40	$416.87	$660.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $194.98 / $338.84	Professional	TC	$125.89	$194.98	$338.84
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $302.00 / $302.00	Professional		$173.78	$302.00	$302.00
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $91.20 / $91.20	Professional	26	$52.48	$91.20	$91.20
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $208.93 / $208.93	Professional	TC	$120.23	$208.93	$208.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $128.82 / $234.42	Professional		$48.98	$128.82	$234.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $245.47 / $446.68	Professional		$147.91	$245.47	$446.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $64.57 / $112.20	Professional	26	$40.74	$64.57	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $173.78 / $331.13	Professional	TC	$107.15	$173.78	$331.13
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $239.88 / $446.68	Professional		$144.54	$239.88	$446.68
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $67.61 / $134.90	Professional	26	$42.66	$67.61	$134.90
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $173.78 / $331.13	Professional	TC	$107.15	$173.78	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $107.15	Professional		$32.36	$33.11	$107.15
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $131.83 / $275.42	Professional		$100.00	$131.83	$275.42
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $58.88 / $100.00	Professional	26	$45.71	$58.88	$100.00
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $70.79 / $165.96	Professional	TC	$54.95	$70.79	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $346.74	Professional		$147.91	$213.80	$346.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $54.95 / $97.72	Professional	26	$40.74	$54.95	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $147.91 / $257.04	Professional	TC	$104.71	$147.91	$257.04