Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $58.88 / $165.96	Professional		$50.12	$58.88	$165.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $36.31 / $194.98	Professional	26	$16.98	$36.31	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $36.31 / $85.11	Professional	TC	$26.92	$36.31	$85.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $12.59 / $26.30	Professional	26	$12.59	$12.59	$26.30
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $18.20 / $18.20	Professional	TC	$18.20	$18.20	$18.20
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $52.48 / $141.25	Professional		$40.74	$52.48	$141.25
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $28.84 / $72.44	Professional	26	$22.39	$28.84	$72.44
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.62 / $23.99 / $63.10	Professional	TC	$18.62	$23.99	$63.10
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $48.98 / $123.03	Professional		$42.66	$48.98	$123.03
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $28.84 / $51.29	Professional	26	$25.12	$28.84	$51.29
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $29.51 / $72.44	Professional	TC	$25.12	$29.51	$72.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $42.66 / $83.18	Facility		$25.70	$42.66	$83.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $48.98 / $87.10	Professional		$25.12	$48.98	$87.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $158.49 / $208.93	Facility		$85.11	$158.49	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $61.66 / $125.89	Professional		$30.90	$61.66	$125.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $27.54 / $58.88	Professional	26	$12.59	$27.54	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $34.67 / $61.66	Professional	TC	$18.20	$34.67	$61.66
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $85.11 / $85.11	Facility		$85.11	$85.11	$85.11
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $61.66 / $138.04	Professional		$30.90	$61.66	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $38.90 / $93.33	Professional	26	$12.59	$38.90	$93.33
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $33.11 / $66.07	Professional	TC	$18.20	$33.11	$66.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $97.72 / $154.88	Professional		$64.57	$97.72	$154.88
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $39.81 / $85.11	Professional	26	$26.92	$39.81	$85.11
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $52.48 / $83.18	Professional	TC	$38.02	$52.48	$83.18
United Facility/Professional Facility Modifier Low / Median / High Price $21.88 / $33.11 / $54.95	Facility		$21.88	$33.11	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $64.57 / $117.49	Professional		$38.90	$64.57	$117.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $28.84 / $57.54	Professional	26	$16.98	$28.84	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $36.31 / $58.88	Professional	TC	$21.88	$36.31	$58.88