Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.04 / $124.17 / $241.35	Facility	26	$75.04	$124.17	$241.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.10 / $144.46 / $245.12	Professional		$124.10	$144.46	$245.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.06 / $78.30 / $142.35	Professional	26	$70.06	$78.30	$142.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.59 / $61.75 / $95.34	Professional	TC	$51.59	$61.75	$95.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $113.03 / $140.84 / $188.39	Professional		$113.03	$140.84	$188.39
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.78 / $85.79 / $102.03	Professional	26	$67.78	$85.79	$102.03
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.02 / $143.78 / $228.28	Professional		$107.02	$143.78	$228.28
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.37 / $80.63 / $127.59	Professional	26	$59.37	$80.63	$127.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $47.65 / $62.78 / $99.48	Professional	TC	$47.65	$62.78	$99.48
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $121.54 / $121.54 / $158.00	Professional		$121.54	$121.54	$158.00
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $72.88 / $72.88 / $94.74	Professional	26	$72.88	$72.88	$94.74
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $48.66 / $48.66 / $63.26	Professional	TC	$48.66	$48.66	$63.26
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.43 / $94.74 / $166.12	Professional		$56.43	$94.74	$166.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $88.73 / $88.73 / $88.73	Facility	26	$88.73	$88.73	$88.73
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.79 / $170.96 / $326.98	Professional		$112.79	$170.96	$326.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.88 / $106.31 / $209.74	Professional	26	$72.88	$106.31	$209.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.97 / $75.84 / $147.59	Professional	TC	$50.97	$75.84	$147.59
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $88.73 / $88.73 / $88.73	Facility	26	$88.73	$88.73	$88.73
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $123.58 / $182.18 / $267.75	Professional		$123.58	$182.18	$267.75
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $72.88 / $106.31 / $209.63	Professional	26	$72.88	$106.31	$209.63
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $49.64 / $74.47 / $125.59	Professional	TC	$49.64	$74.47	$125.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $59.97 / $105.08 / $163.42	Professional		$59.97	$105.08	$163.42
United Facility/Professional Professional Modifier Low / Median / High Price $128.12 / $178.43 / $299.04	Professional		$128.12	$178.43	$299.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.33 / $102.26 / $169.04	Professional	26	$70.33	$102.26	$169.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.61 / $76.80 / $127.58	Professional	TC	$54.61	$76.80	$127.58