Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $354.81 / $741.31	Facility		$83.18	$354.81	$741.31
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $56.23 / $123.03	Facility	26	$36.31	$56.23	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $87.10 / $295.12	Professional		$54.95	$87.10	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $50.12 / $158.49	Professional	26	$33.11	$50.12	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $37.15 / $173.78	Professional	TC	$25.12	$37.15	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $31.62 / $47.86	Professional		$25.12	$31.62	$47.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $36.31 / $72.44	Professional	26	$29.51	$36.31	$72.44
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $15.14 / $25.12	Professional	TC	$14.45	$15.14	$25.12
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 $87.10 / $218.78 / $380.19	Professional		$87.10	$218.78	$380.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $83.18 / $138.04	Professional	26	$50.12	$83.18	$138.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $134.90 / $251.19	Professional	TC	$37.15	$134.90	$251.19
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $44.67 / $83.18	Facility		$25.70	$44.67	$83.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $46.77 / $83.18	Professional		$28.18	$46.77	$83.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $104.71 / $21,379.62	Facility		$104.71	$104.71	$21,379.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $63.10	Facility	26	$9.33	$43.65	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $165.96 / $316.23	Professional		$67.61	$165.96	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $69.18 / $138.04	Professional	26	$38.02	$69.18	$138.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $52.48 / $190.55	Professional	TC	$28.18	$52.48	$190.55
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $275.42 / $794.33	Facility		$34.67	$275.42	$794.33
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $63.10	Facility	26	$9.33	$43.65	$63.10
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $117.49 / $331.13	Professional		$63.10	$117.49	$331.13
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $63.10 / $138.04	Professional	26	$38.02	$63.10	$138.04
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $44.67 / $213.80	Professional	TC	$25.70	$44.67	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $32.36 / $43.65	Professional		$26.30	$32.36	$43.65
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $158.49	Facility		$100.00	$100.00	$158.49
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $158.49	Facility	26	$100.00	$100.00	$158.49
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $81.28 / $275.42	Professional		$66.07	$81.28	$275.42
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $46.77 / $107.15	Professional	26	$38.02	$46.77	$107.15
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $34.67 / $169.82	Professional	TC	$28.18	$34.67	$169.82
United Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $912.01 / $2,951.21	Facility		$309.03	$912.01	$2,951.21
United Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $97.72 / $269.15	Professional		$58.88	$97.72	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $57.54 / $109.65	Professional	26	$33.88	$57.54	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $39.81 / $162.18	Professional	TC	$25.12	$39.81	$162.18