Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.28 / $163.41 / $389.01	Facility	26	$114.28	$163.41	$389.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.45 / $364.49 / $651.36	Professional		$275.45	$364.49	$651.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.48 / $123.66 / $244.33	Professional	26	$105.48	$123.66	$244.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.16 / $237.86 / $428.14	Professional	TC	$170.16	$237.86	$428.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $245.26 / $259.25 / $311.64	Professional		$245.26	$259.25	$311.64
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $85.35 / $105.91 / $167.46	Professional	26	$85.35	$105.91	$167.46
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $167.89 / $167.89 / $167.89	Professional	TC	$167.89	$167.89	$167.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $306.14 / $367.38 / $649.03	Professional		$306.14	$367.38	$649.03
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $113.09 / $130.66 / $236.78	Professional	26	$113.09	$130.66	$236.78
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $231.80 / $410.21	Professional	TC	$190.00	$231.80	$410.21
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $351.05 / $351.05 / $351.05	Professional		$351.05	$351.05	$351.05
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	26	$125.89	$125.89	$125.89
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $225.16 / $225.16 / $225.16	Professional	TC	$225.16	$225.16	$225.16
CareSource Facility/Professional Professional Modifier Low / Median / High Price $117.36 / $247.35 / $419.68	Professional		$117.36	$247.35	$419.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.04 / $128.94 / $128.94	Facility	26	$116.04	$128.94	$128.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $311.63 / $537.86 / $989.21	Professional		$311.63	$537.86	$989.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $98.00 / $151.44 / $254.09	Professional	26	$98.00	$151.44	$254.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.70 / $355.05 / $712.05	Professional	TC	$203.70	$355.05	$712.05
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $116.04 / $116.04 / $128.94	Facility	26	$116.04	$116.04	$128.94
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $311.63 / $490.81 / $989.21	Professional		$311.63	$490.81	$989.21
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $107.19 / $154.82 / $261.36	Professional	26	$107.19	$154.82	$261.36
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $209.89 / $325.82 / $692.92	Professional	TC	$209.89	$325.82	$692.92
Molina Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $212.75 / $381.71	Professional		$98.87	$212.75	$381.71
United Facility/Professional Professional Modifier Low / Median / High Price $318.42 / $439.14 / $822.25	Professional		$318.42	$439.14	$822.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $98.56 / $133.87 / $237.54	Professional	26	$98.56	$133.87	$237.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $208.31 / $293.63 / $581.37	Professional	TC	$208.31	$293.63	$581.37