Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $202.82 / $202.82 / $202.82	Facility	TC	$202.82	$202.82	$202.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.03 / $87.07 / $232.05	Professional		$64.03	$87.07	$232.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.19 / $52.86 / $120.54	Professional	26	$26.19	$52.86	$120.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.27 / $57.67 / $136.47	Professional	TC	$35.27	$57.67	$136.47
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $43.10 / $54.42 / $108.50	Professional		$43.10	$54.42	$108.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.79 / $22.22 / $44.55	Professional	26	$15.79	$22.22	$44.55
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.64 / $58.03 / $150.91	Professional		$44.64	$58.03	$150.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.34 / $21.73 / $69.16	Professional	26	$16.34	$21.73	$69.16
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $29.66 / $38.26 / $94.81	Professional	TC	$29.66	$38.26	$94.81
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $70.98 / $78.08 / $185.56	Professional		$70.98	$78.08	$185.56
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $31.82 / $35.00 / $58.23	Professional	26	$31.82	$35.00	$58.23
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $48.71 / $53.58 / $127.33	Professional	TC	$48.71	$53.58	$127.33
CareSource Facility/Professional Facility Modifier Low / Median / High Price $31.94 / $83.50 / $137.69	Facility		$31.94	$83.50	$137.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.82 / $83.50 / $161.32	Professional		$31.82	$83.50	$161.32
Cigna Facility/Professional Facility Modifier Low / Median / High Price $140.58 / $140.58 / $140.58	Facility		$140.58	$140.58	$140.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.16 / $99.12 / $167.31	Professional		$50.16	$99.12	$167.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.91 / $33.46 / $64.48	Professional	26	$15.91	$33.46	$64.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.22 / $49.59 / $111.33	Professional	TC	$32.22	$49.59	$111.33
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $140.58 / $140.58 / $140.58	Facility		$140.58	$140.58	$140.58
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $47.39 / $97.61 / $181.95	Professional		$47.39	$97.61	$181.95
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $17.94 / $47.35 / $94.98	Professional	26	$17.94	$47.35	$94.98
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $31.21 / $49.59 / $114.81	Professional	TC	$31.21	$49.59	$114.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $35.74 / $83.90 / $179.83	Professional		$35.74	$83.90	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $99.36 / $182.68	Professional		$54.95	$99.36	$182.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.53 / $35.88 / $65.34	Professional	26	$21.53	$35.88	$65.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.83 / $64.44 / $117.34	Professional	TC	$31.83	$64.44	$117.34