Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.10 / $154.63 / $438.90	Professional		$92.10	$154.63	$438.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.79 / $29.98 / $131.13	Professional	26	$28.79	$29.98	$131.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.45 / $99.01 / $409.49	Professional	TC	$62.45	$99.01	$409.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $77.31 / $77.31 / $77.31	Professional		$77.31	$77.31	$77.31
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.60 / $18.51 / $49.37	Professional	26	$17.60	$18.51	$49.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $71.42 / $92.13 / $208.26	Professional		$71.42	$92.13	$208.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.42 / $21.34 / $58.66	Professional	26	$16.42	$21.34	$58.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.01 / $67.11 / $160.40	Professional	TC	$55.01	$67.11	$160.40
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $124.49 / $124.49 / $124.49	Professional		$124.49	$124.49	$124.49
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $40.54 / $40.54 / $40.54	Professional	26	$40.54	$40.54	$40.54
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $96.11 / $96.11 / $96.11	Professional	TC	$96.11	$96.11	$96.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $35.40 / $139.40 / $209.65	Facility		$35.40	$139.40	$209.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $35.26 / $143.26 / $254.68	Professional		$35.26	$143.26	$254.68
Cigna Facility/Professional Facility Modifier Low / Median / High Price $278.32 / $278.32 / $278.32	Facility		$278.32	$278.32	$278.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.31 / $137.88 / $247.80	Professional		$77.31	$137.88	$247.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.63 / $35.26 / $64.17	Professional	26	$17.63	$35.26	$64.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $57.59 / $88.34 / $191.01	Professional	TC	$57.59	$88.34	$191.01
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $278.32 / $278.32 / $278.32	Facility		$278.32	$278.32	$278.32
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $76.39 / $145.07 / $255.16	Professional		$76.39	$145.07	$255.16
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $17.63 / $38.08 / $104.38	Professional	26	$17.63	$38.08	$104.38
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $57.59 / $95.08 / $196.98	Professional	TC	$57.59	$95.08	$196.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $149.61 / $235.85	Professional		$40.43	$149.61	$235.85
United Facility/Professional Professional Modifier Low / Median / High Price $70.81 / $162.08 / $277.02	Professional		$70.81	$162.08	$277.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $39.06 / $60.09	Professional	26	$23.44	$39.06	$60.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.34 / $99.11 / $203.01	Professional	TC	$54.34	$99.11	$203.01