Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.61 / $54.92 / $120.47	Facility	26	$36.61	$54.92	$120.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.63 / $215.90 / $513.60	Professional		$175.63	$215.90	$513.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.37 / $40.95 / $86.14	Professional	26	$28.37	$40.95	$86.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $139.01 / $170.08 / $273.83	Professional	TC	$139.01	$170.08	$273.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.61 / $143.03 / $260.82	Professional		$134.61	$143.03	$260.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.43 / $35.14 / $55.09	Professional	26	$28.43	$35.14	$55.09
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $110.03 / $118.46 / $127.69	Professional	TC	$110.03	$118.46	$127.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $153.88 / $210.01 / $363.97	Professional		$153.88	$210.01	$363.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.61 / $37.57 / $62.47	Professional	26	$26.61	$37.57	$62.47
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $127.28 / $170.60 / $292.35	Professional	TC	$127.28	$170.60	$292.35
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $168.27 / $168.27 / $168.27	Professional		$168.27	$168.27	$168.27
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $35.54 / $35.54 / $35.54	Professional	26	$35.54	$35.54	$35.54
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $132.72 / $132.72 / $132.72	Professional	TC	$132.72	$132.72	$132.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.09 / $162.72 / $235.56	Professional		$39.09	$162.72	$235.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $176.42 / $251.77 / $417.01	Professional		$176.42	$251.77	$417.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.57 / $45.13 / $74.84	Professional	26	$32.57	$45.13	$74.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $139.36 / $208.14 / $358.75	Professional	TC	$139.36	$208.14	$358.75
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $161.54 / $240.72 / $409.69	Professional		$161.54	$240.72	$409.69
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $34.83 / $46.21 / $79.62	Professional	26	$34.83	$46.21	$79.62
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $141.50 / $204.34 / $351.74	Professional	TC	$141.50	$204.34	$351.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $160.36 / $260.54	Professional		$40.43	$160.36	$260.54
United Facility/Professional Professional Modifier Low / Median / High Price $171.95 / $241.89 / $406.45	Professional		$171.95	$241.89	$406.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.37 / $46.34 / $84.97	Professional	26	$29.37	$46.34	$84.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.35 / $193.27 / $340.04	Professional	TC	$138.35	$193.27	$340.04