Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.70 / $72.59 / $1,017.36	Facility	26	$42.70	$72.59	$1,017.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.20 / $98.69 / $272.89	Professional		$81.20	$98.69	$272.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $47.71 / $93.48	Professional	26	$40.29	$47.71	$93.48
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $223.00 / $223.00 / $310.00	Professional	50	$223.00	$223.00	$310.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.92 / $50.05 / $85.15	Professional	TC	$39.92	$50.05	$85.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.15 / $93.61 / $119.35	Professional		$79.15	$93.61	$119.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $50.15 / $58.51	Professional	26	$38.86	$50.15	$58.51
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.23 / $97.80 / $154.97	Professional		$74.23	$97.80	$154.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.14 / $50.78 / $83.46	Professional	26	$40.14	$50.78	$83.46
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $34.08 / $46.78 / $77.39	Professional	TC	$34.08	$46.78	$77.39
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $85.10 / $93.61 / $110.63	Professional		$85.10	$93.61	$110.63
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $41.79 / $45.97 / $54.33	Professional	26	$41.79	$45.97	$54.33
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $43.32 / $47.65 / $56.32	Professional	TC	$43.32	$47.65	$56.32
CareSource Facility/Professional Professional Modifier Low / Median / High Price $45.97 / $58.48 / $114.89	Professional		$45.97	$58.48	$114.89
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.51 / $50.51 / $50.51	Facility	26	$50.51	$50.51	$50.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $82.36 / $119.15 / $203.93	Professional		$82.36	$119.15	$203.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.79 / $61.91 / $115.36	Professional	26	$41.79	$61.91	$115.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.85 / $60.64 / $120.21	Professional	TC	$41.85	$60.64	$120.21
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $50.51 / $50.51 / $50.51	Facility	26	$50.51	$50.51	$50.51
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $81.41 / $125.22 / $180.07	Professional		$81.41	$125.22	$180.07
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $41.41 / $61.43 / $117.00	Professional	26	$41.41	$61.43	$117.00
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $41.85 / $60.64 / $94.72	Professional	TC	$41.85	$60.64	$94.72
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.36 / $46.78 / $124.93	Professional		$28.36	$46.78	$124.93
United Facility/Professional Professional Modifier Low / Median / High Price $79.91 / $121.51 / $198.50	Professional		$79.91	$121.51	$198.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.14 / $57.65 / $97.65	Professional	26	$41.14	$57.65	$97.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.21 / $59.95 / $100.85	Professional	TC	$38.21	$59.95	$100.85