Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $87.10 / $169.82	Professional		$63.10	$87.10	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $169.82 / $776.25	Professional	26	$51.29	$169.82	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $33.11 / $83.18	Professional	TC	$25.12	$33.11	$83.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $28.18 / $56.23	Professional	26	$28.18	$28.18	$56.23
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $109.65 / $213.80	Professional		$75.86	$109.65	$213.80
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $75.86 / $144.54	Professional	26	$53.70	$75.86	$144.54
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $32.36 / $60.26	Professional	TC	$25.70	$32.36	$60.26
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $74.13 / $169.82	Professional		$64.57	$74.13	$169.82
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $64.57 / $102.33	Professional	26	$56.23	$64.57	$102.33
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $28.84 / $66.07	Professional	TC	$25.12	$28.84	$66.07
CareSource Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $64.57 / $128.82	Facility		$36.31	$64.57	$128.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $75.86 / $134.90	Professional		$36.31	$75.86	$134.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $97.72 / $151.36	Professional		$46.77	$97.72	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $57.54 / $104.71	Professional	26	$28.18	$57.54	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $26.30 / $58.88	Professional	TC	$15.85	$26.30	$58.88
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $89.13 / $186.21	Professional		$46.77	$89.13	$186.21
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $79.43 / $154.88	Professional	26	$28.18	$79.43	$154.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $22.39 / $58.88	Professional	TC	$16.22	$22.39	$58.88
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 $97.72 / $125.89 / $213.80	Professional		$97.72	$125.89	$213.80
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $131.83	Professional	26	$58.88	$79.43	$131.83
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $46.77 / $77.62	Professional	TC	$38.02	$46.77	$77.62
United Facility/Professional Facility Modifier Low / Median / High Price $31.62 / $47.86 / $79.43	Facility		$31.62	$47.86	$79.43
United Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $95.50 / $151.36	Professional		$51.29	$95.50	$151.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $60.26 / $95.50	Professional	26	$34.67	$60.26	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $28.84 / $52.48	Professional	TC	$16.22	$28.84	$52.48