Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $32.36 / $47.86	Facility	26	$24.55	$32.36	$47.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $138.04 / $338.84	Professional		$93.33	$138.04	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $37.15 / $91.20	Professional	26	$22.91	$37.15	$91.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $100.00 / $213.80	Professional	TC	$69.18	$100.00	$213.80
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Professional		$117.49	$117.49	$117.49
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $25.12 / $44.67	Professional	26	$19.05	$25.12	$44.67
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $95.50 / $165.96	Professional		$72.44	$95.50	$165.96
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $34.67 / $56.23	Professional	26	$26.30	$34.67	$56.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $58.88 / $120.23	Professional	TC	$42.66	$58.88	$120.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $144.54 / $223.87	Professional		$128.82	$144.54	$223.87
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $31.62 / $48.98	Professional	26	$28.18	$31.62	$48.98
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $112.20 / $177.83	Professional	TC	$100.00	$112.20	$177.83
CareSource Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $104.71 / $173.78	Professional		$26.30	$104.71	$173.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.17 / $28.84 / $40.74	Facility	26	$6.17	$28.84	$40.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $131.83 / $251.19	Professional		$89.13	$131.83	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $33.88 / $57.54	Professional	26	$22.39	$33.88	$57.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $102.33 / $213.80	Professional	TC	$60.26	$102.33	$213.80
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $6.17 / $28.84 / $40.74	Facility	26	$6.17	$28.84	$40.74
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $125.89 / $239.88	Professional		$77.62	$125.89	$239.88
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $34.67 / $72.44	Professional	26	$21.88	$34.67	$72.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $102.33 / $199.53	Professional	TC	$60.26	$102.33	$199.53
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 $117.49 / $144.54 / $257.04	Professional		$117.49	$144.54	$257.04
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $33.11 / $56.23	Professional	26	$25.12	$33.11	$56.23
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $112.20 / $204.17	Professional	TC	$91.20	$112.20	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $123.03 / $223.87	Professional		$75.86	$123.03	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.84 / $48.98	Professional	26	$20.89	$28.84	$48.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $95.50 / $177.83	Professional	TC	$52.48	$95.50	$177.83