Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $134.90 / $398.11	Professional		$104.71	$134.90	$398.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $128.82 / $436.52	Professional	26	$52.48	$128.82	$436.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $74.13 / $162.18	Professional	TC	$53.70	$74.13	$162.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $63.10 / $66.07	Professional	26	$31.62	$63.10	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $81.28 / $251.19	Professional		$63.10	$81.28	$251.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $120.23	Professional	26	$30.20	$40.74	$120.23
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $41.69 / $120.23	Professional	TC	$33.11	$41.69	$120.23
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $316.23	Professional		$109.65	$125.89	$316.23
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $72.44 / $128.82	Professional	26	$63.10	$72.44	$128.82
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $74.13 / $186.21	Professional	TC	$64.57	$74.13	$186.21
CareSource Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $107.15 / $213.80	Facility		$64.57	$107.15	$213.80
CareSource Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $123.03 / $218.78	Professional		$63.10	$123.03	$218.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $190.55 / $281.84	Facility		$104.71	$190.55	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $125.89 / $251.19	Professional		$74.13	$125.89	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $63.10 / $120.23	Professional	26	$31.62	$63.10	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $56.23 / $147.91	Professional	TC	$34.67	$56.23	$147.91
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Facility		$199.53	$199.53	$199.53
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $114.82 / $257.04	Professional		$74.13	$114.82	$257.04
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $85.11 / $151.36	Professional	26	$31.62	$85.11	$151.36
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $51.29 / $147.91	Professional	TC	$37.15	$51.29	$147.91
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 Professional Modifier Low / Median / High Price $165.96 / $208.93 / $363.08	Professional		$165.96	$208.93	$363.08
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $93.33 / $147.91	Professional	26	$67.61	$93.33	$147.91
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $120.23 / $190.55	Professional	TC	$91.20	$120.23	$190.55
United Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $74.13 / $125.89	Facility		$50.12	$74.13	$125.89
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $144.54 / $234.42	Professional		$75.86	$144.54	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $69.18 / $107.15	Professional	26	$38.90	$69.18	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $72.44 / $125.89	Professional	TC	$36.31	$72.44	$125.89