Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $251.19 / $338.84	Facility	26	$194.98	$251.19	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $707.95	Professional		$269.15	$338.84	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $213.80 / $457.09	Professional	26	$169.82	$213.80	$457.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $181.97	Professional	TC	$93.33	$114.82	$181.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $288.40 / $512.86	Professional		$257.04	$288.40	$512.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $223.87 / $331.13	Professional	26	$165.96	$223.87	$331.13
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $323.59 / $524.81	Professional		$234.42	$323.59	$524.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $199.53 / $323.59	Professional	26	$147.91	$199.53	$323.59
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $125.89 / $204.17	Professional	TC	$91.20	$125.89	$204.17
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $263.03 / $338.84	Professional		$263.03	$263.03	$338.84
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $173.78 / $223.87	Professional	26	$173.78	$173.78	$223.87
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $89.13 / $114.82	Professional	TC	$89.13	$89.13	$114.82
CareSource Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $218.78 / $363.08	Professional		$102.33	$218.78	$363.08
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $208.93 / $295.12	Facility	26	$44.67	$208.93	$295.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $389.05 / $724.44	Professional		$263.03	$389.05	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $173.78 / $251.19 / $457.09	Professional	26	$173.78	$251.19	$457.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $141.25 / $269.15	Professional	TC	$93.33	$141.25	$269.15
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $208.93 / $295.12	Facility	26	$44.67	$208.93	$295.12
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $380.19 / $676.08	Professional		$251.19	$380.19	$676.08
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $165.96 / $251.19 / $501.19	Professional	26	$165.96	$251.19	$501.19
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $134.90 / $251.19	Professional	TC	$91.20	$134.90	$251.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
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 $302.00 / $346.74 / $660.69	Professional		$302.00	$346.74	$660.69
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $190.55 / $223.87 / $426.58	Professional	26	$190.55	$223.87	$426.58
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $125.89 / $239.88	Professional	TC	$104.71	$125.89	$239.88
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $602.56	Professional		$251.19	$346.74	$602.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $223.87 / $380.19	Professional	26	$162.18	$223.87	$380.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $128.82 / $218.78	Professional	TC	$93.33	$128.82	$218.78