Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.55 / $68.31 / $165.44	Facility	26	$45.55	$68.31	$165.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.95 / $194.53 / $440.90	Professional		$124.95	$194.53	$440.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.09 / $66.18 / $167.81	Professional	26	$44.09	$66.18	$167.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.84 / $99.56 / $171.20	Professional	TC	$78.84	$99.56	$171.20
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.06 / $123.98 / $182.31	Professional		$97.06	$123.98	$182.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.19 / $45.45 / $62.38	Professional	26	$35.19	$45.45	$62.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $52.35 / $65.44 / $115.49	Professional	TC	$52.35	$65.44	$115.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.35 / $155.43 / $236.78	Professional		$124.35	$155.43	$236.78
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $49.38 / $60.33 / $97.50	Professional	26	$49.38	$60.33	$97.50
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.97 / $90.71 / $152.83	Professional	TC	$74.97	$90.71	$152.83
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $133.71 / $143.43 / $186.46	Professional		$133.71	$143.43	$186.46
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $49.02 / $52.58 / $68.34	Professional	26	$49.02	$52.58	$68.34
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $84.69 / $90.85 / $118.11	Professional	TC	$84.69	$90.85	$118.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $49.02 / $100.09 / $166.45	Professional		$49.02	$100.09	$166.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $121.06 / $173.09 / $283.61	Professional		$121.06	$173.09	$283.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.37 / $63.10 / $98.68	Professional	26	$43.37	$63.10	$98.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.16 / $111.54 / $187.77	Professional	TC	$76.16	$111.54	$187.77
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $119.12 / $170.17 / $273.70	Professional		$119.12	$170.17	$273.70
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $45.85 / $64.79 / $124.76	Professional	26	$45.85	$64.79	$124.76
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $77.20 / $111.54 / $187.77	Professional	TC	$77.20	$111.54	$187.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.54 / $116.67 / $184.17	Professional		$40.54	$116.67	$184.17
United Facility/Professional Professional Modifier Low / Median / High Price $114.04 / $155.22 / $243.18	Professional		$114.04	$155.22	$243.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.71 / $55.32 / $89.73	Professional	26	$40.71	$55.32	$89.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.40 / $96.24 / $152.57	Professional	TC	$72.40	$96.24	$152.57