Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.56 / $78.11 / $148.04	Facility	26	$49.56	$78.11	$148.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.45 / $151.40 / $346.61	Professional		$89.45	$151.40	$346.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.16 / $56.99 / $109.48	Professional	26	$42.16	$56.99	$109.48
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $42.71 / $52.38 / $92.95	Professional	52	$42.71	$52.38	$92.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.82 / $85.14 / $145.04	Professional	TC	$46.82	$85.14	$145.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $87.74 / $122.84	Professional		$81.59	$87.74	$122.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.95 / $53.05 / $63.26	Professional	26	$37.95	$53.05	$63.26
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $21.94 / $30.71 / $30.71	Professional	52	$21.94	$30.71	$30.71
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $114.06 / $300.00 / $470.52	Professional		$114.06	$300.00	$470.52
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.01 / $80.00 / $136.00	Professional	26	$51.01	$80.00	$136.00
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.00 / $220.00 / $344.10	Professional	TC	$61.00	$220.00	$344.10
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $87.74 / $87.74 / $114.06	Professional		$87.74	$87.74	$114.06
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $40.81 / $46.93 / $53.05	Professional	26	$40.81	$46.93	$53.05
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $46.93 / $46.93 / $61.01	Professional	TC	$46.93	$46.93	$61.01
CareSource Facility/Professional Professional Modifier Low / Median / High Price $46.45 / $63.36 / $118.45	Professional		$46.45	$63.36	$118.45
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.80 / $49.80 / $49.80	Facility	26	$49.80	$49.80	$49.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.13 / $161.31 / $329.85	Professional		$92.13	$161.31	$329.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.76 / $71.56 / $135.79	Professional	26	$41.76	$71.56	$135.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.63 / $85.44 / $203.91	Professional	TC	$51.63	$85.44	$203.91
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $49.80 / $49.80 / $49.80	Facility	26	$49.80	$49.80	$49.80
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $89.62 / $130.96 / $314.88	Professional		$89.62	$130.96	$314.88
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $41.97 / $65.29 / $130.40	Professional	26	$41.97	$65.29	$130.40
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $56.94 / $56.94 / $70.40	Professional	52	$56.94	$56.94	$70.40
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $51.63 / $72.75 / $194.93	Professional	TC	$51.63	$72.75	$194.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $38.81 / $76.61 / $125.10	Professional		$38.81	$76.61	$125.10
United Facility/Professional Professional Modifier Low / Median / High Price $103.62 / $179.23 / $283.61	Professional		$103.62	$179.23	$283.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.96 / $68.86 / $111.30	Professional	26	$42.96	$68.86	$111.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.15 / $109.28 / $176.49	Professional	TC	$63.15	$109.28	$176.49