Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $128.82 / $1,548.82	Facility	26	$87.10	$128.82	$1,548.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $398.11 / $1,445.44	Professional		$281.84	$398.11	$1,445.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $97.72 / $323.59	Professional	26	$81.28	$97.72	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $281.84 / $676.08	Professional	TC	$213.80	$281.84	$676.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $275.42 / $416.87	Professional		$223.87	$275.42	$416.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $85.11 / $144.54	Professional	26	$64.57	$85.11	$144.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $257.04 / $281.84	Professional	TC	$158.49	$257.04	$281.84
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $371.54 / $616.60	Professional		$295.12	$371.54	$616.60
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $125.89 / $208.93	Professional	26	$91.20	$125.89	$208.93
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $251.19 / $407.38	Professional	TC	$190.55	$251.19	$407.38
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $363.08 / $562.34	Professional		$323.59	$363.08	$562.34
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $107.15 / $165.96	Professional	26	$95.50	$107.15	$165.96
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $257.04 / $398.11	Professional	TC	$229.09	$257.04	$398.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $245.47 / $436.52	Professional		$89.13	$245.47	$436.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $97.72 / $141.25	Facility	26	$21.38	$97.72	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $416.87 / $741.31	Professional		$269.15	$416.87	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $199.53	Professional	26	$74.13	$114.82	$199.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $302.00 / $537.03	Professional	TC	$190.55	$302.00	$537.03
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $97.72 / $141.25	Facility	26	$21.38	$97.72	$141.25
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $389.05 / $741.31	Professional		$181.97	$389.05	$741.31
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $117.49 / $234.42	Professional	26	$72.44	$117.49	$234.42
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $295.12 / $549.54	Professional	TC	$190.55	$295.12	$549.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $138.04	Professional		$32.36	$33.11	$138.04
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 $186.21 / $316.23 / $512.86	Professional		$186.21	$316.23	$512.86
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $109.65 / $181.97	Professional	26	$81.28	$109.65	$181.97
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $194.98 / $363.08	Professional	TC	$104.71	$194.98	$363.08
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $346.74 / $602.56	Professional		$263.03	$346.74	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $97.72 / $173.78	Professional	26	$74.13	$97.72	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $251.19 / $436.52	Professional	TC	$190.55	$251.19	$436.52