Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.56 / $47.99 / $120.31	Facility	26	$33.56	$47.99	$120.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.49 / $104.98 / $198.01	Professional		$83.49	$104.98	$198.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.34 / $35.77 / $84.57	Professional	26	$31.34	$35.77	$84.57
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $34.90 / $230.00 / $694.50	Professional	50	$34.90	$230.00	$694.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.35 / $70.84 / $122.55	Professional	TC	$60.35	$70.84	$122.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $70.06 / $80.06 / $103.48	Professional		$70.06	$80.06	$103.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.83 / $39.49 / $69.11	Professional	26	$25.83	$39.49	$69.11
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $105.08 / $120.89 / $155.22	Professional	50	$105.08	$120.89	$155.22
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $74.09 / $74.09 / $95.92	Professional	TC	$74.09	$74.09	$95.92
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.96 / $118.83 / $190.09	Professional		$96.96	$118.83	$190.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.39 / $41.35 / $65.87	Professional	26	$33.39	$41.35	$65.87
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $145.44 / $176.57 / $285.14	Professional	50	$145.44	$176.57	$285.14
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.00 / $77.30 / $123.97	Professional	TC	$63.00	$77.30	$123.97
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $109.11 / $109.11 / $120.21	Professional		$109.11	$109.11	$120.21
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.83 / $38.83 / $38.83	Professional	26	$38.83	$38.83	$38.83
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $70.28 / $70.28 / $77.43	Professional	TC	$70.28	$70.28	$77.43
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.20 / $77.43 / $130.94	Professional		$36.20	$77.43	$130.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.69 / $133.22 / $212.68	Professional		$91.69	$133.22	$212.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.13 / $46.28 / $74.31	Professional	26	$32.13	$46.28	$74.31
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $138.68 / $138.68 / $157.99	Professional	50	$138.68	$138.68	$157.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $59.51 / $86.43 / $137.00	Professional	TC	$59.51	$86.43	$137.00
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $92.47 / $134.08 / $212.68	Professional		$92.47	$134.08	$212.68
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $32.94 / $47.34 / $75.68	Professional	26	$32.94	$47.34	$75.68
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $50.39 / $72.15 / $165.75	Professional	50	$50.39	$72.15	$165.75
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $60.43 / $87.37 / $140.02	Professional	TC	$60.43	$87.37	$140.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $82.15 / $132.19	Professional		$40.43	$82.15	$132.19
United Facility/Professional Professional Modifier Low / Median / High Price $87.19 / $117.22 / $185.74	Professional		$87.19	$117.22	$185.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.83 / $41.42 / $66.12	Professional	26	$29.83	$41.42	$66.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $55.30 / $76.84 / $119.56	Professional	TC	$55.30	$76.84	$119.56