Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.49 / $119.39 / $286.93	Facility	26	$83.49	$119.39	$286.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.40 / $213.75 / $392.52	Professional		$184.40	$213.75	$392.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.69 / $95.96 / $183.15	Professional	26	$76.69	$95.96	$183.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.66 / $125.02 / $217.42	Professional	TC	$101.66	$125.02	$217.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.15 / $144.61 / $195.65	Professional		$139.15	$144.61	$195.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.06 / $81.30 / $142.63	Professional	26	$61.06	$81.30	$142.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $73.51 / $143.55 / $143.55	Professional	TC	$73.51	$143.55	$143.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.13 / $248.38 / $483.02	Professional		$199.13	$248.38	$483.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $80.36 / $104.65 / $200.04	Professional	26	$80.36	$104.65	$200.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $115.76 / $143.79 / $301.16	Professional	TC	$115.76	$143.79	$301.16
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $200.75 / $200.75 / $311.33	Professional		$200.75	$200.75	$311.33
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $91.47 / $91.47 / $141.86	Professional	26	$91.47	$91.47	$141.86
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $109.28 / $109.28 / $169.48	Professional	TC	$109.28	$109.28	$169.48
CareSource Facility/Professional Professional Modifier Low / Median / High Price $85.27 / $125.02 / $231.87	Professional		$85.27	$125.02	$231.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.39 / $94.15 / $94.15	Facility	26	$85.39	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $170.13 / $259.20 / $458.07	Professional		$170.13	$259.20	$458.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.56 / $110.65 / $187.15	Professional	26	$71.56	$110.65	$187.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.80 / $148.16 / $263.31	Professional	TC	$97.80	$148.16	$263.31
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $85.39 / $85.39 / $94.15	Facility	26	$85.39	$85.39	$94.15
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $170.13 / $255.36 / $476.36	Professional		$170.13	$255.36	$476.36
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $81.40 / $124.03 / $235.76	Professional	26	$81.40	$124.03	$235.76
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $98.13 / $142.47 / $263.31	Professional	TC	$98.13	$142.47	$263.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $86.55 / $131.01 / $248.41	Professional		$86.55	$131.01	$248.41
United Facility/Professional Professional Modifier Low / Median / High Price $175.01 / $227.21 / $400.41	Professional		$175.01	$227.21	$400.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.78 / $98.45 / $174.90	Professional	26	$74.78	$98.45	$174.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.82 / $125.28 / $220.19	Professional	TC	$96.82	$125.28	$220.19