Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $243.90 / $243.90 / $243.90	Facility	TC	$243.90	$243.90	$243.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $83.34 / $211.92	Professional		$56.63	$83.34	$211.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.98 / $38.67 / $109.99	Professional	26	$19.98	$38.67	$109.99
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $81.63 / $173.92	Professional	TC	$44.43	$81.63	$173.92
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $50.19 / $50.20 / $126.47	Professional		$50.19	$50.20	$126.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.14 / $17.23 / $33.99	Professional	26	$12.14	$17.23	$33.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.74 / $51.26 / $168.44	Professional		$39.74	$51.26	$168.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $14.93 / $45.79	Professional	26	$11.23	$14.93	$45.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.51 / $36.18 / $110.08	Professional	TC	$28.51	$36.18	$110.08
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $70.27 / $73.08 / $183.71	Professional		$70.27	$73.08	$183.71
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $24.28 / $25.25 / $44.43	Professional	26	$24.28	$25.25	$44.43
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $53.28 / $55.41 / $139.28	Professional	TC	$53.28	$55.41	$139.28
CareSource Facility/Professional Facility Modifier Low / Median / High Price $24.36 / $88.68 / $136.11	Facility		$24.36	$88.68	$136.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $24.28 / $91.33 / $165.33	Professional		$24.28	$91.33	$165.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $184.13 / $184.13 / $184.13	Facility		$184.13	$184.13	$184.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.89 / $86.35 / $160.62	Professional		$49.89	$86.35	$160.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.14 / $24.89 / $44.47	Professional	26	$12.14	$24.89	$44.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.35 / $64.03 / $121.77	Professional	TC	$36.35	$64.03	$121.77
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $184.13 / $184.13 / $184.13	Facility		$184.13	$184.13	$184.13
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $46.18 / $86.35 / $160.62	Professional		$46.18	$86.35	$160.62
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $12.14 / $32.78 / $64.72	Professional	26	$12.14	$32.78	$64.72
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $35.04 / $72.23 / $125.57	Professional	TC	$35.04	$72.23	$125.57
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.30 / $115.11 / $187.90	Professional		$40.30	$115.11	$187.90
United Facility/Professional Professional Modifier Low / Median / High Price $52.10 / $98.83 / $181.79	Professional		$52.10	$98.83	$181.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.38 / $27.13 / $46.13	Professional	26	$15.38	$27.13	$46.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.79 / $70.00 / $119.10	Professional	TC	$39.79	$70.00	$119.10