Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.58 / $52.25 / $176.28	Facility	26	$31.58	$52.25	$176.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $110.81 / $166.21 / $380.19	Professional		$110.81	$166.21	$380.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.52 / $52.25 / $117.02	Professional	26	$31.52	$52.25	$117.02
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $49.85 / $55.41 / $190.09	Professional	52	$49.85	$55.41	$190.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.64 / $94.62 / $173.49	Professional	TC	$76.64	$94.62	$173.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $84.96 / $91.88 / $148.68	Professional		$84.96	$91.88	$148.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.44 / $32.22 / $51.35	Professional	26	$24.44	$32.22	$51.35
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.90 / $21.90 / $48.52	Professional	52	$21.90	$21.90	$48.52
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.15 / $60.18 / $80.62	Professional	TC	$51.15	$60.18	$80.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.90 / $119.58 / $186.74	Professional		$91.90	$119.58	$186.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.50 / $41.75 / $67.02	Professional	26	$33.50	$41.75	$67.02
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $57.22 / $74.61 / $117.77	Professional	TC	$57.22	$74.61	$117.77
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $106.52 / $138.06 / $162.91	Professional		$106.52	$138.06	$162.91
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $31.08 / $40.27 / $47.53	Professional	26	$31.08	$40.27	$47.53
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $75.45 / $97.79 / $115.39	Professional	TC	$75.45	$97.79	$115.39
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.08 / $94.07 / $145.15	Professional		$34.08	$94.07	$145.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.71 / $146.07 / $240.92	Professional		$99.71	$146.07	$240.92
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.36 / $44.09 / $69.40	Professional	26	$30.36	$44.09	$69.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.89 / $103.31 / $171.76	Professional	TC	$68.89	$103.31	$171.76
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $99.36 / $146.07 / $237.90	Professional		$99.36	$146.07	$237.90
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $31.85 / $48.02 / $90.69	Professional	26	$31.85	$48.02	$90.69
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $38.40 / $184.08 / $195.52	Professional	52	$38.40	$184.08	$195.52
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $74.45 / $106.96 / $178.30	Professional	TC	$74.45	$106.96	$178.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $115.99 / $181.25	Professional		$40.43	$115.99	$181.25
United Facility/Professional Professional Modifier Low / Median / High Price $88.19 / $131.16 / $212.89	Professional		$88.19	$131.16	$212.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.74 / $39.44 / $62.94	Professional	26	$28.74	$39.44	$62.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.86 / $89.86 / $149.59	Professional	TC	$60.86	$89.86	$149.59