Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $70.79 / $128.82	Facility	26	$45.71	$70.79	$128.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $97.72 / $218.78	Professional		$70.79	$97.72	$218.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $57.54 / $131.83	Professional	26	$38.90	$57.54	$131.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $40.74 / $70.79	Professional	TC	$23.44	$40.74	$70.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $75.86 / $181.97	Professional		$61.66	$75.86	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $43.65 / $43.65	Professional	26	$43.65	$43.65	$43.65
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $89.13 / $151.36	Professional		$67.61	$89.13	$151.36
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $57.54 / $100.00	Professional	26	$43.65	$57.54	$100.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $30.90 / $53.70	Professional	TC	$22.91	$30.90	$53.70
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Professional		$95.50	$95.50	$95.50
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Professional	26	$51.29	$51.29	$51.29
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $45.71 / $45.71	Professional	TC	$45.71	$45.71	$45.71
CareSource Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $60.26 / $112.20	Professional		$34.67	$60.26	$112.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $45.71 / $66.07	Facility	26	$10.00	$45.71	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $95.50 / $165.96	Professional		$69.18	$95.50	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $58.88 / $102.33	Professional	26	$39.81	$58.88	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $40.74 / $75.86	Professional	TC	$24.55	$40.74	$75.86
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $45.71 / $66.07	Facility	26	$10.00	$45.71	$66.07
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $93.33 / $154.88	Professional		$61.66	$93.33	$154.88
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $58.88 / $89.13	Professional	26	$39.81	$58.88	$89.13
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.90 / $72.44	Professional	TC	$23.99	$38.90	$72.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $61.66	Professional		$32.36	$33.11	$61.66
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $45.71 / $45.71	Facility	26	$45.71	$45.71	$45.71
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $91.20 / $151.36	Professional		$77.62	$91.20	$151.36
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $48.98 / $91.20	Professional	26	$41.69	$48.98	$91.20
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $42.66 / $69.18	Professional	TC	$33.11	$42.66	$69.18
United Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $79.43 / $144.54	Professional		$56.23	$79.43	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $48.98 / $85.11	Professional	26	$35.48	$48.98	$85.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $30.90 / $57.54	Professional	TC	$20.42	$30.90	$57.54