Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.86 / $49.85 / $124.94	Facility	26	$34.86	$49.85	$124.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.12 / $149.97 / $252.78	Professional		$112.12	$149.97	$252.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.71 / $47.25 / $96.71	Professional	26	$32.71	$47.25	$96.71
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $17.43 / $55.95 / $100.08	Professional	52	$17.43	$55.95	$100.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.81 / $98.52 / $178.17	Professional	TC	$79.81	$98.52	$178.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.40 / $98.46 / $133.22	Professional		$83.40	$98.46	$133.22
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.34 / $33.40 / $59.80	Professional	26	$27.34	$33.40	$59.80
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.80 / $23.88 / $32.49	Professional	52	$23.80	$23.88	$32.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.73 / $87.75 / $126.57	Professional	TC	$67.73	$87.75	$126.57
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $109.84 / $144.72 / $243.61	Professional		$109.84	$144.72	$243.61
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.98 / $41.38 / $70.20	Professional	26	$31.98	$41.38	$70.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.44 / $103.13 / $175.17	Professional	TC	$78.44	$103.13	$175.17
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $136.69 / $151.75 / $211.99	Professional		$136.69	$151.75	$211.99
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $40.32 / $44.76 / $62.53	Professional	26	$40.32	$44.76	$62.53
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $96.36 / $106.97 / $149.44	Professional	TC	$96.36	$106.97	$149.44
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.59 / $103.09 / $162.18	Professional		$37.59	$103.09	$162.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $44.69	Facility	26	$41.28	$41.28	$44.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.17 / $167.25 / $273.75	Professional		$113.17	$167.25	$273.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.50 / $48.22 / $78.23	Professional	26	$31.50	$48.22	$78.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.70 / $118.62 / $195.56	Professional	TC	$80.70	$118.62	$195.56
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $44.69	Facility	26	$41.28	$41.28	$44.69
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $94.17 / $143.35 / $243.26	Professional		$94.17	$143.35	$243.26
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $35.47 / $44.06 / $66.92	Professional	26	$35.47	$44.06	$66.92
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $27.92 / $70.20 / $91.80	Professional	52	$27.92	$70.20	$91.80
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $81.66 / $114.33 / $186.02	Professional	TC	$81.66	$114.33	$186.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.46 / $117.45 / $184.17	Professional		$40.46	$117.45	$184.17
United Facility/Professional Professional Modifier Low / Median / High Price $118.90 / $156.10 / $258.44	Professional		$118.90	$156.10	$258.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.79 / $43.02 / $73.90	Professional	26	$33.79	$43.02	$73.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $84.34 / $107.27 / $179.01	Professional	TC	$84.34	$107.27	$179.01