Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.95 / $44.72 / $107.67	Facility	26	$31.95	$44.72	$107.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.70 / $106.73 / $187.45	Professional		$93.70	$106.73	$187.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.60 / $34.49 / $85.73	Professional	26	$29.60	$34.49	$85.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $64.14 / $71.48 / $130.10	Professional	TC	$64.14	$71.48	$130.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.58 / $112.34 / $201.70	Professional		$80.58	$112.34	$201.70
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.99 / $40.11 / $54.86	Professional	26	$24.99	$40.11	$54.86
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.21 / $118.89 / $203.80	Professional		$89.21	$118.89	$203.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.73 / $38.58 / $68.56	Professional	26	$29.73	$38.58	$68.56
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $59.31 / $81.59 / $136.02	Professional	TC	$59.31	$81.59	$136.02
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $115.27 / $115.27 / $178.77	Professional		$115.27	$115.27	$178.77
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $36.99 / $36.99 / $57.37	Professional	26	$36.99	$36.99	$57.37
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $78.28 / $78.28 / $121.40	Professional	TC	$78.28	$78.28	$121.40
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.49 / $83.70 / $136.77	Professional		$34.49	$83.70	$136.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.89 / $138.34 / $232.26	Professional		$91.89	$138.34	$232.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $44.40 / $73.50	Professional	26	$28.84	$44.40	$73.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.91 / $94.62 / $161.97	Professional	TC	$61.91	$94.62	$161.97
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $37.82 / $37.82 / $37.82	Facility	26	$37.82	$37.82	$37.82
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $96.94 / $136.76 / $218.82	Professional		$96.94	$136.76	$218.82
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $31.66 / $46.32 / $85.29	Professional	26	$31.66	$46.32	$85.29
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $64.98 / $94.62 / $148.61	Professional	TC	$64.98	$94.62	$148.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.46 / $82.38 / $132.19	Professional		$40.46	$82.38	$132.19
United Facility/Professional Professional Modifier Low / Median / High Price $85.03 / $119.05 / $209.82	Professional		$85.03	$119.05	$209.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.58 / $39.65 / $69.52	Professional	26	$28.58	$39.65	$69.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.47 / $80.67 / $141.93	Professional	TC	$60.47	$80.67	$141.93