Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.70 / $146.96 / $349.29	Facility	26	$98.70	$146.96	$349.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.22 / $197.12 / $435.48	Professional		$130.22	$197.12	$435.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.51 / $136.76 / $289.08	Professional	26	$96.51	$136.76	$289.08
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.52 / $62.09 / $228.06	Professional	TC	$31.52	$62.09	$228.06
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.85 / $108.72 / $136.35	Professional		$97.85	$108.72	$136.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $81.06 / $103.37 / $141.88	Professional	26	$81.06	$103.37	$141.88
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.87 / $263.14 / $466.18	Professional		$169.87	$263.14	$466.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $107.88 / $131.53 / $219.92	Professional	26	$107.88	$131.53	$219.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $44.92 / $149.91 / $252.76	Professional	TC	$44.92	$149.91	$252.76
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $160.36 / $160.36 / $160.36	Professional		$160.36	$160.36	$160.36
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $119.58 / $119.58 / $119.58	Professional	26	$119.58	$119.58	$119.58
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $40.78 / $40.78 / $40.78	Professional	TC	$40.78	$40.78	$40.78
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.52 / $129.74 / $202.40	Professional		$39.52	$129.74	$202.40
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.06 / $167.06 / $167.06	Facility	26	$167.06	$167.06	$167.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.56 / $217.43 / $491.82	Professional		$129.56	$217.43	$491.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $100.82 / $139.65 / $245.28	Professional	26	$100.82	$139.65	$245.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.25 / $51.74 / $317.26	Professional	TC	$31.25	$51.74	$317.26
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $167.06 / $167.06 / $167.06	Facility	26	$167.06	$167.06	$167.06
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $138.61 / $223.99 / $660.94	Professional		$138.61	$223.99	$660.94
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $103.07 / $142.51 / $252.99	Professional	26	$103.07	$142.51	$252.99
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $31.34 / $50.26 / $217.39	Professional	TC	$31.34	$50.26	$217.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.98 / $115.59 / $174.95	Professional		$32.98	$115.59	$174.95
United Facility/Professional Professional Modifier Low / Median / High Price $123.75 / $181.18 / $449.05	Professional		$123.75	$181.18	$449.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $87.39 / $119.61 / $210.52	Professional	26	$87.39	$119.61	$210.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.83 / $38.97 / $157.41	Professional	TC	$23.83	$38.97	$157.41