Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $74.13 / $169.82	Facility	26	$56.23	$74.13	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $204.17 / $776.25	Professional		$112.20	$204.17	$776.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $186.21 / $776.25	Professional	26	$57.54	$186.21	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $100.00 / $380.19	Professional	TC	$57.54	$100.00	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $104.71 / $154.88	Professional		$89.13	$104.71	$154.88
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $77.62	Professional	26	$47.86	$58.88	$77.62
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $194.98 / $302.00	Professional		$144.54	$194.98	$302.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $83.18 / $123.03	Professional	26	$64.57	$83.18	$123.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $109.65 / $173.78	Professional	TC	$77.62	$109.65	$173.78
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $239.88	Professional		$134.90	$169.82	$239.88
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $85.11 / $117.49	Professional	26	$67.61	$85.11	$117.49
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $87.10 / $123.03	Professional	TC	$69.18	$87.10	$123.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $81.28 / $158.49	Professional		$58.88	$81.28	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $181.97 / $316.23	Professional		$117.49	$181.97	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $144.54	Professional	26	$57.54	$79.43	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $100.00 / $181.97	Professional	TC	$58.88	$100.00	$181.97
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $173.78 / $309.03	Professional		$112.20	$173.78	$309.03
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $138.04	Professional	26	$57.54	$79.43	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $91.20 / $158.49	Professional	TC	$58.88	$91.20	$158.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $154.88 / $275.42	Professional		$131.83	$154.88	$275.42
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $75.86 / $123.03	Professional	26	$64.57	$75.86	$123.03
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $79.43 / $141.25	Professional	TC	$66.07	$79.43	$141.25
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $151.36 / $239.88	Professional		$109.65	$151.36	$239.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $67.61 / $112.20	Professional	26	$46.77	$67.61	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $79.43 / $134.90	Professional	TC	$57.54	$79.43	$134.90