Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $338.84 / $870.96	Professional		$281.84	$338.84	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $288.40 / $776.25	Professional	26	$107.15	$288.40	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $223.87 / $562.34	Professional	TC	$181.97	$223.87	$562.34
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	26	$66.07	$66.07	$66.07
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $354.81 / $660.69	Professional		$281.84	$354.81	$660.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $165.96 / $309.03	Professional	26	$131.83	$165.96	$309.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $181.97 / $338.84	Professional	TC	$141.25	$181.97	$338.84
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $309.03 / $776.25	Professional		$295.12	$309.03	$776.25
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $151.36 / $263.03	Professional	26	$144.54	$151.36	$263.03
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $204.17 / $512.86	Professional	TC	$194.98	$204.17	$512.86
CareSource Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $316.23 / $616.60	Professional		$131.83	$316.23	$616.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $371.54 / $707.95	Professional		$194.98	$371.54	$707.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $141.25 / $251.19	Professional	26	$66.07	$141.25	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $208.93 / $426.58	Professional	TC	$104.71	$208.93	$426.58
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $630.96	Professional		$194.98	$281.84	$630.96
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $177.83 / $309.03	Professional	26	$66.07	$177.83	$309.03
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $426.58	Professional	TC	$120.23	$177.83	$426.58
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 $407.38 / $478.63 / $891.25	Professional		$407.38	$478.63	$891.25
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $177.83 / $302.00	Professional	26	$138.04	$177.83	$302.00
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $269.15 / $316.23 / $588.84	Professional	TC	$269.15	$316.23	$588.84
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $398.11 / $645.65	Professional		$173.78	$398.11	$645.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $138.04 / $223.87	Professional	26	$77.62	$138.04	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $234.42 / $398.11	Professional	TC	$102.33	$234.42	$398.11