Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $89.78 / $89.78 / $89.78	Facility	TC	$89.78	$89.78	$89.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.44 / $35.68 / $99.04	Professional		$27.44	$35.68	$99.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $13.28 / $45.41	Professional	26	$8.56	$13.28	$45.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.56 / $28.03 / $75.30	Professional	TC	$21.56	$28.03	$75.30
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $16.32 / $19.22 / $70.36	Professional		$16.32	$19.22	$70.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $5.13 / $7.69 / $14.56	Professional	26	$5.13	$7.69	$14.56
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.18 / $19.18 / $19.18	Professional	TC	$19.18	$19.18	$19.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.40 / $48.74 / $95.64	Professional		$38.40	$48.74	$95.64
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.60 / $14.08 / $26.43	Professional	26	$11.60	$14.08	$26.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $26.80 / $34.57 / $66.59	Professional	TC	$26.80	$34.57	$66.59
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $26.90 / $29.59 / $49.96	Professional		$26.90	$29.59	$49.96
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $10.40 / $11.44 / $13.52	Professional	26	$10.40	$11.44	$13.52
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $19.62 / $21.58 / $36.44	Professional	TC	$19.62	$21.58	$36.44
CareSource Facility/Professional Facility Modifier Low / Median / High Price $10.41 / $33.29 / $52.04	Facility		$10.41	$33.29	$52.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $10.40 / $33.64 / $63.30	Professional		$10.40	$33.64	$63.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $67.09 / $67.09 / $67.09	Facility		$67.09	$67.09	$67.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.22 / $42.29 / $83.47	Professional		$19.22	$42.29	$83.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.20 / $11.25 / $21.30	Professional	26	$5.20	$11.25	$21.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $14.02 / $29.74 / $56.07	Professional	TC	$14.02	$29.74	$56.07
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $67.09 / $67.09 / $67.09	Facility		$67.09	$67.09	$67.09
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $15.74 / $42.36 / $96.00	Professional		$15.74	$42.36	$96.00
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $5.32 / $15.40 / $31.04	Professional	26	$5.32	$15.40	$31.04
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $13.85 / $30.84 / $56.07	Professional	TC	$13.85	$30.84	$56.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.10 / $36.50 / $53.74	Professional		$22.10	$36.50	$53.74
United Facility/Professional Professional Modifier Low / Median / High Price $23.45 / $39.08 / $72.25	Professional		$23.45	$39.08	$72.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.59 / $11.56 / $17.87	Professional	26	$6.59	$11.56	$17.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.48 / $27.46 / $50.77	Professional	TC	$16.48	$27.46	$50.77