Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.18 / $88.92 / $200.21	Facility	26	$58.18	$88.92	$200.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.58 / $284.33 / $622.37	Professional		$194.58	$284.33	$622.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $58.71 / $105.64	Professional	26	$52.78	$58.71	$105.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.32 / $220.00 / $489.53	Professional	TC	$137.32	$220.00	$489.53
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.34 / $147.34 / $147.34	Professional		$147.34	$147.34	$147.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $75.31 / $89.18	Professional	26	$41.81	$75.31	$89.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $230.59 / $268.56 / $449.98	Professional		$230.59	$268.56	$449.98
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.59 / $67.84 / $120.57	Professional	26	$60.59	$67.84	$120.57
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $155.82 / $204.00 / $339.23	Professional	TC	$155.82	$204.00	$339.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $211.02 / $211.02 / $211.02	Professional		$211.02	$211.02	$211.02
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $63.48 / $63.48 / $63.48	Professional	26	$63.48	$63.48	$63.48
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $147.52 / $147.52 / $147.52	Professional	TC	$147.52	$147.52	$147.52
CareSource Facility/Professional Professional Modifier Low / Median / High Price $59.18 / $137.52 / $217.32	Professional		$59.18	$137.52	$217.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.58 / $65.64 / $65.64	Facility	26	$59.58	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.20 / $326.89 / $611.34	Professional		$189.20	$326.89	$611.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.88 / $76.79 / $131.00	Professional	26	$49.88	$76.79	$131.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $135.72 / $253.66 / $477.29	Professional	TC	$135.72	$253.66	$477.29
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $59.58 / $59.58 / $65.64	Facility	26	$59.58	$59.58	$65.64
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $189.20 / $320.14 / $611.34	Professional		$189.20	$320.14	$611.34
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $54.57 / $78.02 / $131.00	Professional	26	$54.57	$78.02	$131.00
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $137.52 / $226.62 / $474.20	Professional	TC	$137.52	$226.62	$474.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.46 / $162.86 / $261.30	Professional		$40.46	$162.86	$261.30
United Facility/Professional Professional Modifier Low / Median / High Price $203.05 / $283.62 / $511.78	Professional		$203.05	$283.62	$511.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.16 / $70.05 / $135.53	Professional	26	$51.16	$70.05	$135.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.97 / $231.08 / $387.91	Professional	TC	$151.97	$231.08	$387.91