Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.06 / $93.88 / $230.29	Facility	26	$67.06	$93.88	$230.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.30 / $299.11 / $587.44	Professional		$234.30	$299.11	$587.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.68 / $70.78 / $188.87	Professional	26	$60.68	$70.78	$188.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.43 / $214.05 / $443.97	Professional	TC	$170.43	$214.05	$443.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $170.04 / $195.19 / $206.42	Professional		$170.04	$195.19	$206.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.91 / $60.63 / $108.54	Professional	26	$48.91	$60.63	$108.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $240.75 / $240.75 / $240.75	Professional	TC	$240.75	$240.75	$240.75
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $260.05 / $299.72 / $520.20	Professional		$260.05	$299.72	$520.20
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.05 / $78.80 / $141.06	Professional	26	$70.05	$78.80	$141.06
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $224.20 / $379.14	Professional	TC	$190.00	$224.20	$379.14
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $279.48 / $279.48 / $279.48	Professional		$279.48	$279.48	$279.48
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $73.18 / $73.18 / $73.18	Professional	26	$73.18	$73.18	$73.18
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $206.29 / $206.29 / $206.29	Professional	TC	$206.29	$206.29	$206.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $68.22 / $220.71 / $331.59	Professional		$68.22	$220.71	$331.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.53 / $75.64 / $75.64	Facility	26	$68.53	$75.64	$75.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $248.16 / $374.76 / $746.67	Professional		$248.16	$374.76	$746.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.49 / $89.20 / $150.76	Professional	26	$57.49	$89.20	$150.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.99 / $286.51 / $557.36	Professional	TC	$181.99	$286.51	$557.36
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $68.53 / $68.53 / $75.64	Facility	26	$68.53	$68.53	$75.64
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $248.16 / $372.77 / $705.30	Professional		$248.16	$372.77	$705.30
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $64.01 / $93.31 / $173.67	Professional	26	$64.01	$93.31	$173.67
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $181.99 / $279.72 / $554.41	Professional	TC	$181.99	$279.72	$554.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $65.67 / $175.33 / $297.41	Professional		$65.67	$175.33	$297.41
United Facility/Professional Professional Modifier Low / Median / High Price $243.54 / $333.19 / $582.44	Professional		$243.54	$333.19	$582.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.07 / $80.89 / $146.75	Professional	26	$59.07	$80.89	$146.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.83 / $248.78 / $448.92	Professional	TC	$176.83	$248.78	$448.92