Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $138.04 / $204.17	Facility	26	$104.71	$138.04	$204.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $478.63 / $1,412.54	Professional		$316.23	$478.63	$1,412.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $169.82 / $512.86	Professional	26	$97.72	$169.82	$512.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $275.42 / $588.84	Professional	TC	$208.93	$275.42	$588.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $269.15 / $630.96	Professional		$229.09	$269.15	$630.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $114.82 / $194.98	Professional	26	$81.28	$114.82	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $478.63 / $776.25	Professional		$363.08	$478.63	$776.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $141.25 / $234.42	Professional	26	$112.20	$141.25	$234.42
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $331.13 / $537.03	Professional	TC	$245.47	$331.13	$537.03
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $389.05 / $645.65	Professional		$371.54	$389.05	$645.65
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $128.82 / $208.93	Professional	26	$123.03	$128.82	$208.93
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $263.03 / $426.58	Professional	TC	$251.19	$263.03	$426.58
CareSource Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $263.03 / $478.63	Professional		$114.82	$263.03	$478.63
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $501.19 / $851.14	Professional		$316.23	$501.19	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $144.54 / $251.19	Professional	26	$93.33	$144.54	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $338.84 / $588.84	Professional	TC	$223.87	$338.84	$588.84
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $125.89 / $177.83	Facility	26	$26.92	$125.89	$177.83
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $467.74 / $870.96	Professional		$295.12	$467.74	$870.96
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $144.54 / $239.88	Professional	26	$93.33	$144.54	$239.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $323.59 / $602.56	Professional	TC	$223.87	$323.59	$602.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $213.80	Professional		$32.36	$33.11	$213.80
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $281.84 / $549.54	Professional		$218.78	$281.84	$549.54
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $128.82 / $229.09	Professional	26	$102.33	$128.82	$229.09
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $169.82 / $380.19	Professional	TC	$112.20	$169.82	$380.19
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $501.19 / $1,047.13	Professional		$331.13	$501.19	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $114.82 / $199.53	Professional	26	$74.13	$114.82	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $346.74 / $891.25	Professional	TC	$229.09	$346.74	$891.25