Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.25 / $150.51 / $377.30	Facility	26	$105.25	$150.51	$377.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.27 / $435.47 / $695.28	Professional		$323.27	$435.47	$695.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $103.20 / $140.00 / $236.81	Professional	26	$103.20	$140.00	$236.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $222.00 / $259.35 / $447.23	Professional	TC	$222.00	$259.35	$447.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.21 / $266.91 / $314.00	Professional		$251.21	$266.91	$314.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.56 / $134.16 / $180.60	Professional	26	$82.56	$134.16	$180.60
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $326.20 / $415.40 / $747.23	Professional		$326.20	$415.40	$747.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $97.78 / $128.22 / $229.44	Professional	26	$97.78	$128.22	$229.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $227.29 / $288.45 / $522.32	Professional	TC	$227.29	$288.45	$522.32
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $370.53 / $370.53 / $574.64	Professional		$370.53	$370.53	$574.64
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $121.78 / $121.78 / $188.86	Professional	26	$121.78	$121.78	$188.86
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $248.76 / $248.76 / $385.78	Professional	TC	$248.76	$248.76	$385.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $113.52 / $266.01 / $439.61	Professional		$113.52	$266.01	$439.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.31 / $124.62 / $124.62	Facility	26	$112.31	$124.62	$124.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $320.62 / $490.86 / $832.04	Professional		$320.62	$490.86	$832.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.73 / $147.11 / $245.76	Professional	26	$94.73	$147.11	$245.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $221.35 / $337.30 / $579.47	Professional	TC	$221.35	$337.30	$579.47
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $112.31 / $112.31 / $124.62	Facility	26	$112.31	$112.31	$124.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $325.22 / $489.60 / $784.87	Professional		$325.22	$489.60	$784.87
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $101.13 / $147.49 / $261.44	Professional	26	$101.13	$147.49	$261.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $231.16 / $330.96 / $575.12	Professional	TC	$231.16	$330.96	$575.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $99.93 / $245.73 / $425.35	Professional		$99.93	$245.73	$425.35
United Facility/Professional Professional Modifier Low / Median / High Price $327.96 / $515.61 / $1,052.77	Professional		$327.96	$515.61	$1,052.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.65 / $121.07 / $223.54	Professional	26	$76.65	$121.07	$223.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $254.30 / $369.63 / $865.06	Professional	TC	$254.30	$369.63	$865.06