Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $586.12 / $586.12 / $586.12	Facility	TC	$586.12	$586.12	$586.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.92 / $259.68 / $484.79	Professional		$182.92	$259.68	$484.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.63 / $83.58 / $382.85	Professional	26	$60.63	$83.58	$382.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.24 / $181.87 / $359.94	Professional	TC	$152.24	$181.87	$359.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.13 / $129.13 / $335.76	Professional		$129.13	$129.13	$335.76
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.13 / $54.04 / $104.34	Professional	26	$37.13	$54.04	$104.34
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $91.87 / $91.87 / $91.87	Professional	TC	$91.87	$91.87	$91.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.25 / $259.02 / $455.04	Professional		$199.25	$259.02	$455.04
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.53 / $101.50 / $190.88	Professional	26	$84.53	$101.50	$190.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $103.93 / $135.26 / $293.98	Professional	TC	$103.93	$135.26	$293.98
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $180.80 / $198.88 / $472.65	Professional		$180.80	$198.88	$472.65
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $74.53 / $81.98 / $136.38	Professional	26	$74.53	$81.98	$136.38
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $128.62 / $141.47 / $336.24	Professional	TC	$128.62	$141.47	$336.24
CareSource Facility/Professional Facility Modifier Low / Median / High Price $74.81 / $219.54 / $350.33	Facility		$74.81	$219.54	$350.33
CareSource Facility/Professional Professional Modifier Low / Median / High Price $74.53 / $220.49 / $425.37	Professional		$74.53	$220.49	$425.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $446.05 / $446.05 / $446.05	Facility		$446.05	$446.05	$446.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $129.13 / $247.96 / $446.78	Professional		$129.13	$247.96	$446.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $80.84 / $153.25	Professional	26	$37.27	$80.84	$153.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.13 / $146.72 / $310.08	Professional	TC	$88.13	$146.72	$310.08
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $446.05 / $446.05 / $446.05	Facility		$446.05	$446.05	$446.05
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $113.71 / $208.00 / $426.15	Professional		$113.71	$208.00	$426.15
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $110.65 / $207.31	Professional	26	$39.97	$110.65	$207.31
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $88.13 / $174.32 / $354.83	Professional	TC	$88.13	$174.32	$354.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $96.10 / $202.66 / $389.24	Professional		$96.10	$202.66	$389.24
United Facility/Professional Professional Modifier Low / Median / High Price $154.97 / $262.74 / $485.76	Professional		$154.97	$262.74	$485.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.33 / $83.91 / $129.93	Professional	26	$47.33	$83.91	$129.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $103.06 / $178.46 / $324.98	Professional	TC	$103.06	$178.46	$324.98