Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.62 / $63.86 / $165.44	Facility	26	$45.62	$63.86	$165.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.00 / $165.59 / $438.66	Professional		$140.00	$165.59	$438.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.89 / $56.93 / $124.59	Professional	26	$42.89	$56.93	$124.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $96.58 / $113.62 / $193.59	Professional	TC	$96.58	$113.62	$193.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.67 / $121.62 / $131.66	Professional		$114.67	$121.62	$131.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.43 / $44.04 / $73.41	Professional	26	$35.43	$44.04	$73.41
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.06 / $106.00 / $130.16	Professional	TC	$95.06	$106.00	$130.16
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.26 / $177.60 / $319.87	Professional		$136.26	$177.60	$319.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.29 / $54.15 / $95.21	Professional	26	$41.29	$54.15	$95.21
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $94.96 / $124.54 / $222.93	Professional	TC	$94.96	$124.54	$222.93
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $168.85 / $168.85 / $261.85	Professional		$168.85	$168.85	$261.85
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $52.26 / $52.26 / $81.05	Professional	26	$52.26	$52.26	$81.05
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $116.58 / $116.58 / $180.80	Professional	TC	$116.58	$116.58	$180.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $48.72 / $124.54 / $200.33	Professional		$48.72	$124.54	$200.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $59.03	Facility	26	$54.02	$54.02	$59.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $140.26 / $207.64 / $341.73	Professional		$140.26	$207.64	$341.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.22 / $62.71 / $103.01	Professional	26	$41.22	$62.71	$103.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $97.71 / $145.22 / $239.82	Professional	TC	$97.71	$145.22	$239.82
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $59.03	Facility	26	$54.02	$54.02	$59.03
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $140.26 / $200.32 / $341.73	Professional		$140.26	$200.32	$341.73
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $45.43 / $66.86 / $129.78	Professional	26	$45.43	$66.86	$129.78
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $99.04 / $142.87 / $236.63	Professional	TC	$99.04	$142.87	$236.63
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.51 / $127.70 / $221.83	Professional		$40.51	$127.70	$221.83
United Facility/Professional Professional Modifier Low / Median / High Price $146.59 / $185.01 / $325.49	Professional		$146.59	$185.01	$325.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.67 / $56.15 / $97.72	Professional	26	$43.67	$56.15	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.10 / $132.30 / $227.77	Professional	TC	$102.10	$132.30	$227.77