Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $1,862.09 / $10,232.93	Facility		$575.44	$1,862.09	$10,232.93
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $165.96 / $416.87	Facility	26	$123.03	$165.96	$416.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $489.78 / $1,513.56	Professional		$346.74	$489.78	$1,513.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $162.18 / $338.84	Professional	26	$117.49	$162.18	$338.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $295.12 / $478.63	Professional	TC	$234.42	$295.12	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $363.08 / $398.11	Professional		$331.13	$363.08	$398.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $245.47 / $245.47	Professional	TC	$245.47	$245.47	$245.47
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,318.26 / $2,137.96 / $2,511.89	Facility		$1,318.26	$2,137.96	$2,511.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $380.19 / $660.69	Professional		$316.23	$380.19	$660.69
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $147.91 / $263.03	Professional	26	$123.03	$147.91	$263.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $229.09 / $398.11	Professional	TC	$186.21	$229.09	$398.11
CareSource Facility/Professional Facility Modifier Low / Median / High Price $120.23 / $239.88 / $436.52	Facility		$120.23	$239.88	$436.52
CareSource Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $281.84 / $436.52	Professional		$151.36	$281.84	$436.52
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,379.62 / $21,379.62 / $21,379.62	Facility		$21,379.62	$21,379.62	$21,379.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $467.74 / $691.83	Professional		$338.84	$467.74	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $177.83 / $269.15	Professional	26	$123.03	$177.83	$269.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $288.40 / $457.09	Professional	TC	$208.93	$288.40	$457.09
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $741.31 / $1,122.02	Facility		$380.19	$741.31	$1,122.02
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $457.09 / $707.95	Professional		$346.74	$457.09	$707.95
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $177.83 / $269.15	Professional	26	$123.03	$177.83	$269.15
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $288.40 / $457.09	Professional	TC	$218.78	$288.40	$457.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $89.13	Professional		$32.36	$33.11	$89.13
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $851.14	Facility		$100.00	$100.00	$851.14
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $851.14	Facility	26	$100.00	$100.00	$851.14
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $407.38 / $776.25	Professional		$346.74	$407.38	$776.25
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $151.36 / $288.40	Professional	26	$128.82	$151.36	$288.40
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $257.04 / $489.78	Professional	TC	$218.78	$257.04	$489.78
United Facility/Professional Facility Modifier Low / Median / High Price $954.99 / $1,862.09 / $4,073.80	Facility		$954.99	$1,862.09	$4,073.80
United Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $407.38 / $691.83	Professional		$309.03	$407.38	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $154.88 / $239.88	Professional	26	$112.20	$154.88	$239.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $257.04 / $426.58	Professional	TC	$190.55	$257.04	$426.58