Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $177.83 / $239.88	Facility	26	$138.04	$177.83	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $281.84 / $588.84	Professional		$199.53	$281.84	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $169.82 / $323.59	Professional	26	$120.23	$169.82	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $93.33 / $158.49	Professional	TC	$75.86	$93.33	$158.49
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $223.87 / $389.05	Professional		$190.55	$223.87	$389.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $162.18 / $251.19	Professional	26	$123.03	$162.18	$251.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $239.88 / $389.05	Professional		$173.78	$239.88	$389.05
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $141.25 / $229.09	Professional	26	$104.71	$141.25	$229.09
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $100.00 / $158.49	Professional	TC	$70.79	$100.00	$158.49
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $251.19 / $416.87	Professional		$190.55	$251.19	$416.87
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $158.49 / $257.04	Professional	26	$120.23	$158.49	$257.04
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $91.20 / $162.18	Professional	TC	$69.18	$91.20	$162.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $158.49 / $269.15	Professional		$79.43	$158.49	$269.15
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $147.91 / $208.93	Facility	26	$31.62	$147.91	$208.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $288.40 / $537.03	Professional		$194.98	$288.40	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $177.83 / $323.59	Professional	26	$120.23	$177.83	$323.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $114.82 / $218.78	Professional	TC	$75.86	$114.82	$218.78
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $147.91 / $208.93	Facility	26	$31.62	$147.91	$208.93
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $478.63	Professional		$190.55	$281.84	$478.63
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $173.78 / $323.59	Professional	26	$117.49	$173.78	$323.59
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $107.15 / $199.53	Professional	TC	$72.44	$107.15	$199.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $81.28	Professional		$32.36	$33.11	$81.28
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $269.15 / $489.78	Professional		$218.78	$269.15	$489.78
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $165.96 / $302.00	Professional	26	$134.90	$165.96	$302.00
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $97.72 / $186.21	Professional	TC	$83.18	$97.72	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $263.03 / $446.68	Professional		$190.55	$263.03	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $158.49 / $269.15	Professional	26	$114.82	$158.49	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $107.15 / $181.97	Professional	TC	$77.62	$107.15	$181.97