Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $63.10 / $93.33	Facility	26	$47.86	$63.10	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $151.36 / $457.09	Professional		$46.77	$151.36	$457.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $75.86 / $218.78	Professional	26	$44.67	$75.86	$218.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $138.04 / $302.00 / $1,513.56	Professional	50	$138.04	$302.00	$1,513.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $141.25 / $371.54	Professional	TC	$81.28	$141.25	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $109.65 / $223.87	Professional		$89.13	$109.65	$223.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $50.12 / $85.11	Professional	26	$35.48	$50.12	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $97.72 / $162.18	Professional	TC	$97.72	$97.72	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $275.42 / $436.52	Professional		$177.83	$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 $263.03 / $407.38 / $660.69	Professional	50	$263.03	$407.38	$660.69
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $190.55 / $331.13	Professional	TC	$107.15	$190.55	$331.13
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $151.36 / $245.47	Professional		$141.25	$151.36	$245.47
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $56.23 / $91.20	Professional	26	$52.48	$56.23	$91.20
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $93.33 / $154.88	Professional	TC	$89.13	$93.33	$154.88
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $102.33 / $177.83	Professional		$48.98	$102.33	$177.83
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 $128.82 / $218.78 / $416.87	Professional		$128.82	$218.78	$416.87
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 $83.18 / $151.36 / $316.23	Professional	TC	$83.18	$151.36	$316.23
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 $112.20 / $204.17 / $416.87	Professional		$112.20	$204.17	$416.87
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $69.18 / $138.04	Professional	26	$40.74	$69.18	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $147.91 / $331.13	Professional	TC	$83.18	$147.91	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $95.50	Professional		$32.36	$33.11	$95.50
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 $85.11 / $138.04 / $239.88	Professional		$85.11	$138.04	$239.88
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $57.54 / $100.00	Professional	26	$45.71	$57.54	$100.00
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $64.57 / $151.36	Professional	TC	$39.81	$64.57	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $331.13	Professional		$128.82	$190.55	$331.13
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 $85.11 / $125.89 / $239.88	Professional	TC	$85.11	$125.89	$239.88