Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $178.41 / $178.41 / $178.41	Facility	TC	$178.41	$178.41	$178.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $53.79 / $82.91 / $215.16	Professional		$53.79	$82.91	$215.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.01 / $60.04 / $338.69	Professional	26	$21.01	$60.04	$338.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $56.98 / $197.00	Professional	TC	$37.11	$56.98	$197.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $34.72 / $43.41 / $92.89	Professional		$34.72	$43.41	$92.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $12.86 / $18.30 / $36.15	Professional	26	$12.86	$18.30	$36.15
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $49.23 / $129.88	Professional		$37.86	$49.23	$129.88
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.95 / $14.93 / $37.96	Professional	26	$11.95	$14.93	$37.96
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.92 / $33.43 / $79.30	Professional	TC	$25.92	$33.43	$79.30
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $60.77 / $66.84 / $158.86	Professional		$60.77	$66.84	$158.86
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $25.82 / $28.40 / $47.25	Professional	26	$25.82	$28.40	$47.25
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $42.70 / $46.97 / $111.63	Professional	TC	$42.70	$46.97	$111.63
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.91 / $73.20 / $117.91	Facility		$25.91	$73.20	$117.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $25.82 / $73.20 / $141.43	Professional		$25.82	$73.20	$141.43
Cigna Facility/Professional Facility Modifier Low / Median / High Price $124.90 / $124.90 / $124.90	Facility		$124.90	$124.90	$124.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.01 / $79.43 / $138.90	Professional		$43.01	$79.43	$138.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.91 / $25.52 / $43.84	Professional	26	$12.91	$25.52	$43.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.66 / $49.13 / $97.60	Professional	TC	$28.66	$49.13	$97.60
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $124.90 / $124.90 / $124.90	Facility		$124.90	$124.90	$124.90
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $38.18 / $83.84 / $156.87	Professional		$38.18	$83.84	$156.87
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $12.75 / $26.17 / $58.02	Professional	26	$12.75	$26.17	$58.02
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $27.40 / $56.61 / $100.65	Professional	TC	$27.40	$56.61	$100.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.74 / $78.78 / $134.96	Professional		$35.74	$78.78	$134.96
United Facility/Professional Professional Modifier Low / Median / High Price $52.77 / $87.95 / $162.60	Professional		$52.77	$87.95	$162.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.18 / $28.63 / $42.02	Professional	26	$16.18	$28.63	$42.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.47 / $59.11 / $93.67	Professional	TC	$35.47	$59.11	$93.67