Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $176.39 / $299.86 / $567.04	Facility	26	$176.39	$299.86	$567.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $259.14 / $291.57 / $510.34	Professional		$259.14	$291.57	$510.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $161.72 / $181.53 / $318.61	Professional	26	$161.72	$181.53	$318.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.54 / $113.86 / $174.46	Professional	TC	$93.54	$113.86	$174.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $243.37 / $274.45 / $405.15	Professional		$243.37	$274.45	$405.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $160.26 / $215.40 / $267.10	Professional	26	$160.26	$215.40	$267.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $231.24 / $306.05 / $493.24	Professional		$231.24	$306.05	$493.24
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $140.87 / $190.60 / $303.30	Professional	26	$140.87	$190.60	$303.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $90.36 / $115.61 / $188.66	Professional	TC	$90.36	$115.61	$188.66
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $339.81 / $339.81 / $339.81	Professional		$339.81	$339.81	$339.81
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $224.02 / $224.02 / $224.02	Professional	26	$224.02	$224.02	$224.02
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $115.79 / $115.79 / $115.79	Professional	TC	$115.79	$115.79	$115.79
CareSource Facility/Professional Professional Modifier Low / Median / High Price $103.25 / $224.02 / $357.69	Professional		$103.25	$224.02	$357.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $208.62 / $208.62 / $208.62	Facility	26	$208.62	$208.62	$208.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $196.86 / $365.95 / $693.28	Professional		$196.86	$365.95	$693.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $172.32 / $251.77 / $498.70	Professional	26	$172.32	$251.77	$498.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $90.23 / $138.86 / $269.29	Professional	TC	$90.23	$138.86	$269.29
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $208.62 / $208.62 / $208.62	Facility	26	$208.62	$208.62	$208.62
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $261.39 / $391.75 / $627.25	Professional		$261.39	$391.75	$627.25
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $172.32 / $249.87 / $482.51	Professional	26	$172.32	$249.87	$482.51
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $89.64 / $135.26 / $238.15	Professional	TC	$89.64	$135.26	$238.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $89.95 / $205.66 / $359.74	Professional		$89.95	$205.66	$359.74
United Facility/Professional Professional Modifier Low / Median / High Price $263.81 / $386.96 / $674.85	Professional		$263.81	$386.96	$674.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $166.46 / $238.13 / $396.33	Professional	26	$166.46	$238.13	$396.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.58 / $133.77 / $225.04	Professional	TC	$95.58	$133.77	$225.04