Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $37.15 / $54.95	Facility	26	$27.54	$37.15	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $125.89 / $371.54	Professional		$74.13	$125.89	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $43.65 / $97.72	Professional	26	$26.30	$43.65	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $87.10 / $218.78	Professional	TC	$47.86	$87.10	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $81.28	Professional		$67.61	$67.61	$81.28
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $25.70 / $51.29	Professional	26	$20.89	$25.70	$51.29
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $93.33 / $154.88	Professional		$69.18	$93.33	$154.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $34.67 / $57.54	Professional	26	$27.54	$34.67	$57.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $58.88 / $109.65	Professional	TC	$41.69	$58.88	$109.65
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $109.65 / $114.82	Professional		$109.65	$109.65	$114.82
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $32.36	Professional	26	$30.90	$30.90	$32.36
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $77.62 / $81.28	Professional	TC	$77.62	$77.62	$81.28
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $83.18 / $147.91	Professional		$28.84	$83.18	$147.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $131.83 / $251.19	Professional		$87.10	$131.83	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $37.15 / $64.57	Professional	26	$23.44	$37.15	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $93.33 / $181.97	Professional	TC	$60.26	$93.33	$181.97
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $31.62 / $44.67	Facility	26	$6.76	$31.62	$44.67
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $251.19	Professional		$85.11	$125.89	$251.19
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $35.48 / $72.44	Professional	26	$21.88	$35.48	$72.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $91.20 / $177.83	Professional	TC	$60.26	$91.20	$177.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.45 / $32.36 / $39.81	Professional		$14.45	$32.36	$39.81
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $79.43 / $134.90	Professional		$61.66	$79.43	$134.90
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $33.11 / $57.54	Professional	26	$26.30	$33.11	$57.54
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $77.62	Professional	TC	$34.67	$45.71	$77.62
United Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $107.15 / $190.55	Professional		$79.43	$107.15	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $29.51 / $54.95	Professional	26	$22.91	$29.51	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $77.62 / $134.90	Professional	TC	$53.70	$77.62	$134.90