Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $113.73 / $148.97 / $390.29	Facility	26	$113.73	$148.97	$390.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $274.47 / $366.55 / $776.39	Professional		$274.47	$366.55	$776.39
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.45 / $121.89 / $308.05	Professional	26	$104.45	$121.89	$308.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $170.47 / $246.22 / $565.09	Professional	TC	$170.47	$246.22	$565.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $242.91 / $310.35 / $328.62	Professional		$242.91	$310.35	$328.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $83.56 / $129.34 / $185.22	Professional	26	$83.56	$129.34	$185.22
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $284.20 / $377.26 / $630.78	Professional		$284.20	$377.26	$630.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.21 / $127.08 / $243.03	Professional	26	$94.21	$127.08	$243.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $236.73 / $387.33	Professional	TC	$190.00	$236.73	$387.33
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $443.94 / $443.94 / $443.94	Professional		$443.94	$443.94	$443.94
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $124.89 / $124.89 / $124.89	Professional	26	$124.89	$124.89	$124.89
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $319.05 / $319.05 / $319.05	Professional	TC	$319.05	$319.05	$319.05
CareSource Facility/Professional Professional Modifier Low / Median / High Price $116.42 / $341.15 / $526.71	Professional		$116.42	$341.15	$526.71
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.10 / $128.28 / $128.28	Facility	26	$116.10	$128.28	$128.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $373.38 / $568.32 / $1,110.51	Professional		$373.38	$568.32	$1,110.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.21 / $148.85 / $252.81	Professional	26	$96.21	$148.85	$252.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $264.97 / $420.62 / $820.91	Professional	TC	$264.97	$420.62	$820.91
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $116.10 / $116.10 / $128.28	Facility	26	$116.10	$116.10	$128.28
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $373.38 / $568.32 / $1,074.58	Professional		$373.38	$568.32	$1,074.58
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $106.69 / $155.59 / $253.81	Professional	26	$106.69	$155.59	$253.81
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $270.38 / $408.79 / $788.70	Professional	TC	$270.38	$408.79	$788.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $98.87 / $180.48 / $338.70	Professional		$98.87	$180.48	$338.70
United Facility/Professional Professional Modifier Low / Median / High Price $390.96 / $521.42 / $891.07	Professional		$390.96	$521.42	$891.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $99.10 / $132.83 / $241.80	Professional	26	$99.10	$132.83	$241.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $281.14 / $373.41 / $638.33	Professional	TC	$281.14	$373.41	$638.33