Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.25 / $63.34 / $164.26	Facility	26	$45.25	$63.34	$164.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.88 / $178.05 / $506.20	Professional		$109.88	$178.05	$506.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.79 / $64.98 / $168.00	Professional	26	$43.79	$64.98	$168.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.28 / $79.34 / $137.02	Professional	TC	$63.28	$79.34	$137.02
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.99 / $105.87 / $164.13	Professional		$81.99	$105.87	$164.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.40 / $45.15 / $70.81	Professional	26	$35.40	$45.15	$70.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $92.45 / $92.45	Professional	TC	$69.65	$92.45	$92.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.70 / $148.46 / $233.02	Professional		$120.70	$148.46	$233.02
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.87 / $59.98 / $94.75	Professional	26	$49.87	$59.98	$94.75
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.83 / $82.16 / $141.34	Professional	TC	$70.83	$82.16	$141.34
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $124.95 / $137.66 / $162.44	Professional		$124.95	$137.66	$162.44
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.23 / $57.54 / $67.90	Professional	26	$52.23	$57.54	$67.90
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $72.72 / $80.12 / $94.54	Professional	TC	$72.72	$80.12	$94.54
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.69 / $80.12 / $144.19	Professional		$48.69	$80.12	$144.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.89 / $153.54 / $243.55	Professional		$105.89	$153.54	$243.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.37 / $62.39 / $99.15	Professional	26	$43.37	$62.39	$99.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.01 / $91.14 / $148.10	Professional	TC	$61.01	$91.14	$148.10
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $105.89 / $150.19 / $241.12	Professional		$105.89	$150.19	$241.12
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $45.10 / $66.51 / $123.96	Professional	26	$45.10	$66.51	$123.96
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $62.02 / $91.14 / $150.96	Professional	TC	$62.02	$91.14	$150.96
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 $99.61 / $135.13 / $213.17	Professional		$99.61	$135.13	$213.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.26 / $55.27 / $89.14	Professional	26	$40.26	$55.27	$89.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.90 / $80.02 / $122.56	Professional	TC	$58.90	$80.02	$122.56