Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $115.92 / $115.92 / $115.92	Facility	TC	$115.92	$115.92	$115.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $76.43 / $92.54 / $221.18	Professional		$76.43	$92.54	$221.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.31 / $87.72 / $615.60	Professional	26	$46.31	$87.72	$615.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.31 / $31.59 / $70.43	Professional	TC	$29.31	$31.59	$70.43
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.22 / $42.41 / $79.17	Professional	26	$28.22	$42.41	$79.17
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.38 / $114.42 / $211.17	Professional		$80.38	$114.42	$211.17
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.23 / $75.72 / $143.58	Professional	26	$54.23	$75.72	$143.58
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.78 / $32.72 / $60.91	Professional	TC	$25.78	$32.72	$60.91
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $71.26 / $74.50 / $169.35	Professional		$71.26	$74.50	$169.35
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $62.21 / $65.03 / $103.49	Professional	26	$62.21	$65.03	$103.49
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $27.71 / $28.97 / $65.86	Professional	TC	$27.71	$28.97	$65.86
CareSource Facility/Professional Facility Modifier Low / Median / High Price $36.58 / $69.76 / $126.62	Facility		$36.58	$69.76	$126.62
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.24 / $73.52 / $135.66	Professional		$36.24	$73.52	$135.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.77 / $87.77 / $87.77	Facility		$87.77	$87.77	$87.77
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.27 / $92.54 / $148.06	Professional		$46.27	$92.54	$148.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.27 / $57.74 / $114.86	Professional	26	$28.27	$57.74	$114.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.04 / $28.37 / $59.38	Professional	TC	$16.04	$28.37	$59.38
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $87.77 / $87.77 / $87.77	Facility		$87.77	$87.77	$87.77
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $46.27 / $97.16 / $187.64	Professional		$46.27	$97.16	$187.64
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $28.27 / $73.51 / $149.43	Professional	26	$28.27	$73.51	$149.43
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $16.04 / $33.95 / $62.98	Professional	TC	$16.04	$33.95	$62.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.67 / $69.51 / $128.85	Professional		$30.67	$69.51	$128.85
United Facility/Professional Professional Modifier Low / Median / High Price $57.36 / $95.60 / $174.09	Professional		$57.36	$95.60	$174.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.25 / $62.91 / $97.98	Professional	26	$35.25	$62.91	$97.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.30 / $31.68 / $58.42	Professional	TC	$16.30	$31.68	$58.42