Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.87 / $206.63 / $401.95	Facility	26	$124.87	$206.63	$401.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.70 / $218.33 / $387.60	Professional		$195.70	$218.33	$387.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.73 / $132.38 / $236.88	Professional	26	$116.73	$132.38	$236.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.94 / $89.92 / $137.05	Professional	TC	$74.94	$89.92	$137.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $221.90 / $296.38	Professional		$177.83	$221.90	$296.38
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.84 / $151.66 / $188.08	Professional	26	$112.84	$151.66	$188.08
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $170.30 / $228.81 / $363.26	Professional		$170.30	$228.81	$363.26
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.95 / $133.88 / $213.04	Professional	26	$98.95	$133.88	$213.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.34 / $92.24 / $148.96	Professional	TC	$71.34	$92.24	$148.96
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $191.21 / $191.21 / $210.33	Professional		$191.21	$191.21	$210.33
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $121.34 / $121.34 / $133.47	Professional	26	$121.34	$121.34	$133.47
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $69.88 / $69.88 / $76.87	Professional	TC	$69.88	$69.88	$76.87
CareSource Facility/Professional Professional Modifier Low / Median / High Price $81.12 / $157.74 / $261.52	Professional		$81.12	$157.74	$261.52
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $269.74 / $521.94	Professional		$145.22	$269.74	$521.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $121.34 / $176.97 / $350.54	Professional	26	$121.34	$176.97	$350.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.37 / $111.80 / $216.69	Professional	TC	$73.37	$111.80	$216.69
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $147.65 / $147.65 / $147.65	Facility	26	$147.65	$147.65	$147.65
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $191.21 / $284.39 / $421.06	Professional		$191.21	$284.39	$421.06
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $121.34 / $176.04 / $335.43	Professional	26	$121.34	$176.04	$335.43
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $72.12 / $108.31 / $188.03	Professional	TC	$72.12	$108.31	$188.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $60.28 / $140.67 / $279.38	Professional		$60.28	$140.67	$279.38
United Facility/Professional Professional Modifier Low / Median / High Price $197.32 / $281.06 / $471.85	Professional		$197.32	$281.06	$471.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $119.63 / $171.88 / $297.82	Professional	26	$119.63	$171.88	$297.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $80.72 / $115.11 / $185.16	Professional	TC	$80.72	$115.11	$185.16