Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.73 / $104.13 / $257.27	Professional		$69.73	$104.13	$257.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.16 / $46.96 / $207.40	Professional	26	$31.16	$46.96	$207.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.21 / $60.71 / $137.05	Professional	TC	$50.21	$60.71	$137.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $57.65 / $57.65 / $208.92	Professional		$57.65	$57.65	$208.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $28.08 / $52.99	Professional	26	$18.89	$28.08	$52.99
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.58 / $70.40 / $178.33	Professional		$54.58	$70.40	$178.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $26.54 / $90.73	Professional	26	$20.42	$26.54	$90.73
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.86 / $45.51 / $108.35	Professional	TC	$35.86	$45.51	$108.35
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $82.95 / $82.95 / $197.15	Professional		$82.95	$82.95	$197.15
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $41.64 / $41.64 / $69.27	Professional	26	$41.64	$41.64	$69.27
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $53.81 / $53.81 / $127.88	Professional	TC	$53.81	$53.81	$127.88
CareSource Facility/Professional Facility Modifier Low / Median / High Price $37.99 / $83.86 / $146.25	Facility		$37.99	$83.86	$146.25
CareSource Facility/Professional Professional Modifier Low / Median / High Price $37.85 / $90.84 / $162.02	Professional		$37.85	$90.84	$162.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $164.85 / $164.85 / $164.85	Facility		$164.85	$164.85	$164.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.86 / $107.73 / $179.02	Professional		$53.86	$107.73	$179.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.92 / $40.81 / $77.42	Professional	26	$18.92	$40.81	$77.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.94 / $61.95 / $115.30	Professional	TC	$34.94	$61.95	$115.30
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $164.85 / $164.85 / $164.85	Facility		$164.85	$164.85	$164.85
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $53.86 / $94.55 / $177.75	Professional		$53.86	$94.55	$177.75
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $19.25 / $55.63 / $102.66	Professional	26	$19.25	$55.63	$102.66
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $34.94 / $69.88 / $130.81	Professional	TC	$34.94	$69.88	$130.81
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 $68.26 / $118.20 / $202.76	Professional		$68.26	$118.20	$202.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.76 / $42.94 / $78.19	Professional	26	$25.76	$42.94	$78.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.93 / $76.33 / $129.75	Professional	TC	$41.93	$76.33	$129.75