Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.40 / $158.93 / $310.29	Facility	26	$90.40	$158.93	$310.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $254.55 / $341.78 / $688.45	Professional		$254.55	$341.78	$688.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.39 / $95.56 / $263.87	Professional	26	$82.39	$95.56	$263.87
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $172.18 / $172.18 / $172.18	Professional	50	$172.18	$172.18	$172.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.48 / $246.22 / $508.96	Professional	TC	$170.48	$246.22	$508.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.51 / $155.51 / $311.01	Professional		$155.51	$155.51	$311.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.40 / $84.70 / $209.46	Professional	26	$67.40	$84.70	$209.46
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $231.07 / $322.14 / $535.58	Professional		$231.07	$322.14	$535.58
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $61.07 / $96.24 / $191.96	Professional	26	$61.07	$96.24	$191.96
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $346.60 / $479.81 / $803.37	Professional	50	$346.60	$479.81	$803.37
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $170.00 / $221.00 / $346.56	Professional	TC	$170.00	$221.00	$346.56
CareSource Facility/Professional Professional Modifier Low / Median / High Price $92.68 / $232.58 / $325.26	Professional		$92.68	$232.58	$325.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $92.32 / $101.96 / $101.96	Facility	26	$92.32	$101.96	$101.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $310.47 / $472.55 / $893.27	Professional		$310.47	$472.55	$893.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.47 / $119.32 / $201.56	Professional	26	$77.47	$119.32	$201.56
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $458.57 / $458.57 / $458.57	Professional	50	$458.57	$458.57	$458.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $225.20 / $344.97 / $687.18	Professional	TC	$225.20	$344.97	$687.18
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $92.32 / $92.32 / $101.96	Facility	26	$92.32	$92.32	$101.96
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $310.47 / $476.80 / $862.48	Professional		$310.47	$476.80	$862.48
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $84.79 / $122.65 / $208.12	Professional	26	$84.79	$122.65	$208.12
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $227.97 / $340.68 / $687.18	Professional	TC	$227.97	$340.68	$687.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $180.48 / $337.88	Professional		$98.87	$180.48	$337.88
United Facility/Professional Professional Modifier Low / Median / High Price $314.14 / $404.33 / $746.79	Professional		$314.14	$404.33	$746.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.44 / $107.56 / $192.00	Professional	26	$75.44	$107.56	$192.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.98 / $311.64 / $536.44	Professional	TC	$225.98	$311.64	$536.44