Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $109.65 / $302.00	Professional		$85.11	$109.65	$302.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $125.89 / $660.69	Professional	26	$33.11	$125.89	$660.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $66.07 / $120.23	Professional	TC	$48.98	$66.07	$120.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $19.05 / $38.02	Professional	26	$19.05	$19.05	$38.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $70.79 / $177.83	Professional		$54.95	$70.79	$177.83
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $26.30 / $91.20	Professional	26	$20.42	$26.30	$91.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $44.67 / $107.15	Professional	TC	$35.48	$44.67	$107.15
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $87.10 / $229.09	Professional		$83.18	$87.10	$229.09
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $43.65 / $77.62	Professional	26	$41.69	$43.65	$77.62
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $56.23 / $151.36	Professional	TC	$53.70	$56.23	$151.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $81.28 / $147.91	Facility		$38.90	$81.28	$147.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $91.20 / $165.96	Professional		$38.02	$91.20	$165.96
Cigna Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Facility		$165.96	$165.96	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $112.20 / $213.80	Professional		$53.70	$112.20	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $39.81 / $79.43	Professional	26	$19.05	$39.81	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $60.26 / $117.49	Professional	TC	$34.67	$60.26	$117.49
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Facility		$165.96	$165.96	$165.96
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $91.20 / $173.78	Professional		$53.70	$91.20	$173.78
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $56.23 / $100.00	Professional	26	$19.05	$56.23	$100.00
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $56.23 / $131.83	Professional	TC	$34.67	$56.23	$131.83
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 $117.49 / $158.49 / $263.03	Professional		$117.49	$158.49	$263.03
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $95.50	Professional	26	$39.81	$57.54	$95.50
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $95.50 / $173.78	Professional	TC	$77.62	$95.50	$173.78
United Facility/Professional Facility Modifier Low / Median / High Price $45.71 / $67.61 / $114.82	Facility		$45.71	$67.61	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $117.49 / $190.55	Professional		$66.07	$117.49	$190.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $42.66 / $70.79	Professional	26	$25.70	$42.66	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $66.07 / $120.23	Professional	TC	$34.67	$66.07	$120.23