Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $144.54 / $218.78	Facility	26	$107.15	$144.54	$218.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $524.81 / $1,548.82	Professional		$251.19	$524.81	$1,548.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $169.82 / $380.19	Professional	26	$102.33	$169.82	$380.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $407.38 / $1,023.29	Professional	TC	$281.84	$407.38	$1,023.29
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $338.84 / $512.86	Professional		$251.19	$338.84	$512.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $120.23 / $169.82	Professional	26	$75.86	$120.23	$169.82
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $478.63 / $794.33	Professional		$346.74	$478.63	$794.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $120.23 / $218.78	Professional	26	$85.11	$120.23	$218.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $346.74 / $575.44	Professional	TC	$257.04	$346.74	$575.44
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Professional		$467.74	$467.74	$467.74
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	26	$125.89	$125.89	$125.89
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $338.84	Professional	TC	$338.84	$338.84	$338.84
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $630.96 / $1,348.96	Professional		$371.54	$630.96	$1,348.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $229.09	Professional	26	$89.13	$138.04	$229.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $478.63 / $1,096.48	Professional	TC	$281.84	$478.63	$1,096.48
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $117.49 / $165.96	Facility	26	$25.12	$117.49	$165.96
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $616.60 / $1,412.54	Professional		$354.81	$616.60	$1,412.54
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $138.04 / $269.15	Professional	26	$91.20	$138.04	$269.15
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $457.09 / $1,096.48	Professional	TC	$269.15	$457.09	$1,096.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $309.03	Professional		$32.36	$33.11	$309.03
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $302.00 / $676.08	Professional		$234.42	$302.00	$676.08
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $125.89 / $213.80	Professional	26	$97.72	$125.89	$213.80
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $177.83 / $446.68	Professional	TC	$134.90	$177.83	$446.68
United Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $549.54 / $1,096.48	Professional		$371.54	$549.54	$1,096.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $112.20 / $204.17	Professional	26	$85.11	$112.20	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $398.11 / $851.14	Professional	TC	$275.42	$398.11	$851.14