Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.28 / $43.79 / $113.42	Facility	26	$31.28	$43.79	$113.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.53 / $125.82 / $359.53	Professional		$95.53	$125.82	$359.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $39.07 / $124.15	Professional	26	$29.75	$39.07	$124.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.06 / $89.62 / $166.93	Professional	TC	$65.06	$89.62	$166.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.73 / $84.53 / $123.12	Professional		$75.73	$84.53	$123.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.20 / $30.25 / $52.24	Professional	26	$24.20	$30.25	$52.24
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.76 / $51.22 / $73.47	Professional	TC	$27.76	$51.22	$73.47
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $90.39 / $118.38 / $185.74	Professional		$90.39	$118.38	$185.74
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $34.68 / $42.65 / $67.20	Professional	26	$34.68	$42.65	$67.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.71 / $71.81 / $110.14	Professional	TC	$55.71	$71.81	$110.14
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $111.76 / $111.76 / $124.07	Professional		$111.76	$111.76	$124.07
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $36.21 / $36.21 / $40.20	Professional	26	$36.21	$36.21	$40.20
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $75.54 / $75.54 / $83.87	Professional	TC	$75.54	$75.54	$83.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.76 / $80.05 / $129.55	Professional		$33.76	$80.05	$129.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.14 / $134.24 / $228.77	Professional		$93.14	$134.24	$228.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.15 / $43.38 / $68.51	Professional	26	$29.15	$43.38	$68.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.51 / $90.83 / $156.62	Professional	TC	$61.51	$90.83	$156.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $94.43 / $137.33 / $231.23	Professional		$94.43	$137.33	$231.23
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $31.55 / $47.23 / $89.77	Professional	26	$31.55	$47.23	$89.77
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $64.23 / $90.93 / $166.19	Professional	TC	$64.23	$90.93	$166.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $81.81 / $132.19	Professional		$40.43	$81.81	$132.19
United Facility/Professional Professional Modifier Low / Median / High Price $85.87 / $119.51 / $189.72	Professional		$85.87	$119.51	$189.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.47 / $38.88 / $66.52	Professional	26	$28.47	$38.88	$66.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.30 / $83.18 / $130.06	Professional	TC	$59.30	$83.18	$130.06