Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $138.04 / $199.53	Facility	26	$104.71	$138.04	$199.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $501.19 / $1,380.38	Professional		$338.84	$501.19	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $141.25 / $354.81	Professional	26	$93.33	$141.25	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $354.81 / $660.69	Professional	TC	$223.87	$354.81	$660.69
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $323.59 / $691.83	Professional		$257.04	$323.59	$691.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $102.33 / $173.78	Professional	26	$77.62	$102.33	$173.78
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $645.65 / $1,096.48	Professional		$457.09	$645.65	$1,096.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $131.83 / $218.78	Professional	26	$104.71	$131.83	$218.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $512.86 / $891.25	Professional	TC	$338.84	$512.86	$891.25
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $645.65 / $707.95	Professional		$407.38	$645.65	$707.95
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $181.97 / $199.53	Professional	26	$114.82	$181.97	$199.53
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $467.74 / $512.86	Professional	TC	$295.12	$467.74	$512.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $309.03 / $549.54	Professional		$107.15	$309.03	$549.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $117.49 / $169.82	Facility	26	$25.70	$117.49	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $562.34 / $1,023.29	Professional		$331.13	$562.34	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $138.04 / $239.88	Professional	26	$87.10	$138.04	$239.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $416.87 / $812.83	Professional	TC	$245.47	$416.87	$812.83
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $117.49 / $169.82	Facility	26	$25.70	$117.49	$169.82
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $537.03 / $1,023.29	Professional		$316.23	$537.03	$1,023.29
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $141.25 / $281.84	Professional	26	$89.13	$141.25	$281.84
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $407.38 / $812.83	Professional	TC	$239.88	$407.38	$812.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $223.87	Professional		$32.36	$33.11	$223.87
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $436.52 / $812.83	Professional		$239.88	$436.52	$812.83
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $138.04 / $218.78	Professional	26	$97.72	$138.04	$218.78
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $199.53 / $501.19	Professional	TC	$131.83	$199.53	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $812.83	Professional		$338.84	$478.63	$812.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $117.49 / $208.93	Professional	26	$89.13	$117.49	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $346.74 / $616.60	Professional	TC	$245.47	$346.74	$616.60