Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $35.48 / $56.23	Facility	26	$27.54	$35.48	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $104.71 / $257.04	Professional		$77.62	$104.71	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $41.69 / $83.18	Professional	26	$23.44	$41.69	$83.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $72.44 / $158.49	Professional	TC	$53.70	$72.44	$158.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $28.84 / $51.29	Professional	26	$23.44	$28.84	$51.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $89.13 / $144.54	Professional		$67.61	$89.13	$144.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.90 / $50.12	Professional	26	$23.44	$30.90	$50.12
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $56.23 / $95.50	Professional	TC	$43.65	$56.23	$95.50
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $107.15 / $162.18	Professional		$102.33	$107.15	$162.18
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $33.11 / $50.12	Professional	26	$31.62	$33.11	$50.12
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $74.13 / $112.20	Professional	TC	$70.79	$74.13	$112.20
CareSource Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $74.13 / $134.90	Professional		$29.51	$74.13	$134.90
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	26	$6.92	$32.36	$46.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $194.98	Professional		$75.86	$109.65	$194.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $33.11 / $60.26	Professional	26	$22.39	$33.11	$60.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $83.18 / $147.91	Professional	TC	$53.70	$83.18	$147.91
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $32.36 / $46.77	Facility	26	$6.92	$32.36	$46.77
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $199.53	Professional		$72.44	$104.71	$199.53
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $34.67 / $67.61	Professional	26	$22.39	$34.67	$67.61
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $77.62 / $154.88	Professional	TC	$52.48	$77.62	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $114.82 / $204.17	Professional		$91.20	$114.82	$204.17
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $35.48 / $63.10	Professional	26	$28.18	$35.48	$63.10
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $79.43 / $141.25	Professional	TC	$63.10	$79.43	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $95.50 / $165.96	Professional		$64.57	$95.50	$165.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $29.51 / $50.12	Professional	26	$20.89	$29.51	$50.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $66.07 / $117.49	Professional	TC	$44.67	$66.07	$117.49