Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $72.44 / $107.15	Facility	26	$56.23	$72.44	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $199.53 / $524.81	Professional		$93.33	$199.53	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $229.09	Professional	26	$52.48	$95.50	$229.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $173.78 / $426.58	Professional	TC	$112.20	$173.78	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $147.91 / $165.96	Professional		$147.91	$147.91	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $100.00	Professional	26	$40.74	$51.29	$100.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $281.84 / $446.68	Professional		$229.09	$281.84	$446.68
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $120.23	Professional	26	$57.54	$74.13	$120.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $204.17 / $346.74	Professional	TC	$147.91	$204.17	$346.74
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $316.23	Professional		$181.97	$181.97	$316.23
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $104.71	Professional	26	$60.26	$60.26	$104.71
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $120.23 / $208.93	Professional	TC	$120.23	$120.23	$208.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $125.89 / $229.09	Professional		$56.23	$125.89	$229.09
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $275.42 / $512.86	Professional		$162.18	$275.42	$512.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $74.13 / $128.82	Professional	26	$46.77	$74.13	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $190.55 / $389.05	Professional	TC	$109.65	$190.55	$389.05
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $269.15 / $524.81	Professional		$151.36	$269.15	$524.81
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $74.13 / $138.04	Professional	26	$47.86	$74.13	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $186.21 / $407.38	Professional	TC	$107.15	$186.21	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $134.90 / $309.03	Professional		$107.15	$134.90	$309.03
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $114.82	Professional	26	$52.48	$66.07	$114.82
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $67.61 / $199.53	Professional	TC	$53.70	$67.61	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $234.42 / $398.11	Professional		$158.49	$234.42	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $60.26 / $112.20	Professional	26	$46.77	$60.26	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $165.96 / $302.00	Professional	TC	$109.65	$165.96	$302.00