Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.15 / $134.60 / $329.80	Facility	26	$96.15	$134.60	$329.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $340.50 / $409.51 / $716.08	Professional		$340.50	$409.51	$716.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.57 / $120.96 / $217.59	Professional	26	$89.57	$120.96	$217.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $244.35 / $304.31 / $547.79	Professional	TC	$244.35	$304.31	$547.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $247.62 / $255.19 / $325.64	Professional		$247.62	$255.19	$325.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $71.66 / $114.66 / $164.82	Professional	26	$71.66	$114.66	$164.82
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $174.68 / $340.92 / $340.92	Professional	TC	$174.68	$340.92	$340.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $303.89 / $370.74 / $639.47	Professional		$303.89	$370.74	$639.47
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.22 / $120.91 / $232.17	Professional	26	$93.22	$120.91	$232.17
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $243.04 / $405.27	Professional	TC	$190.00	$243.04	$405.27
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $365.23 / $365.23 / $365.23	Professional		$365.23	$365.23	$365.23
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $105.69 / $105.69 / $105.69	Professional	26	$105.69	$105.69	$105.69
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $259.54 / $259.54 / $259.54	Professional	TC	$259.54	$259.54	$259.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $98.53 / $277.58 / $433.33	Professional		$98.53	$277.58	$433.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.23 / $108.46 / $108.46	Facility	26	$98.23	$108.46	$108.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $312.99 / $474.07 / $863.79	Professional		$312.99	$474.07	$863.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.43 / $126.98 / $214.54	Professional	26	$82.43	$126.98	$214.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $229.16 / $351.45 / $640.99	Professional	TC	$229.16	$351.45	$640.99
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $98.23 / $98.23 / $108.46	Facility	26	$98.23	$98.23	$108.46
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $303.33 / $471.12 / $876.23	Professional		$303.33	$471.12	$876.23
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $90.17 / $138.69 / $262.10	Professional	26	$90.17	$138.69	$262.10
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $230.94 / $346.72 / $638.65	Professional	TC	$230.94	$346.72	$638.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $244.59 / $425.35	Professional		$98.87	$244.59	$425.35
United Facility/Professional Professional Modifier Low / Median / High Price $318.48 / $412.95 / $715.14	Professional		$318.48	$412.95	$715.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.97 / $113.62 / $204.98	Professional	26	$83.97	$113.62	$204.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $230.38 / $298.14 / $542.08	Professional	TC	$230.38	$298.14	$542.08