Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $65.77 / $280.64 / $622.54	Facility		$65.77	$280.64	$622.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.63 / $62.27 / $123.92	Facility	26	$36.63	$62.27	$123.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.04 / $88.07 / $238.29	Professional		$60.04	$88.07	$238.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.29 / $47.30 / $109.87	Professional	26	$34.29	$47.30	$109.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.88 / $33.19 / $150.03	Professional	TC	$25.88	$33.19	$150.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $23.83 / $30.10 / $47.65	Professional		$23.83	$30.10	$47.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $149.97 / $149.97 / $149.97	Professional	26	$149.97	$149.97	$149.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $10.41 / $10.41 / $11.97	Professional	TC	$10.41	$10.41	$11.97
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.00 / $1,398.00 / $2,170.00	Facility		$937.00	$1,398.00	$2,170.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.63 / $195.23 / $337.79	Professional		$74.63	$195.23	$337.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.84 / $77.20 / $125.36	Professional	26	$42.84	$77.20	$125.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.11 / $123.70 / $225.60	Professional	TC	$31.11	$123.70	$225.60
CareSource Facility/Professional Facility Modifier Low / Median / High Price $25.62 / $41.42 / $79.66	Facility		$25.62	$41.42	$79.66
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.30 / $44.88 / $80.34	Professional		$28.30	$44.88	$80.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $71.95 / $71.95 / $21,571.00	Facility		$71.95	$71.95	$21,571.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.98 / $41.98 / $41.98	Facility	26	$41.98	$41.98	$41.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.91 / $123.93 / $332.07	Professional		$64.91	$123.93	$332.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.97 / $66.91 / $140.11	Professional	26	$37.97	$66.91	$140.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.95 / $50.08 / $197.75	Professional	TC	$26.95	$50.08	$197.75
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $71.95 / $253.24 / $399.86	Facility		$71.95	$253.24	$399.86
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $41.98 / $41.98 / $41.98	Facility	26	$41.98	$41.98	$41.98
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $64.91 / $111.19 / $306.72	Professional		$64.91	$111.19	$306.72
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $37.06 / $56.95 / $129.76	Professional	26	$37.06	$56.95	$129.76
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $25.77 / $40.02 / $189.53	Professional	TC	$25.77	$40.02	$189.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.36 / $46.40 / $84.58	Professional		$28.36	$46.40	$84.58
United Facility/Professional Facility Modifier Low / Median / High Price $117.53 / $796.00 / $2,914.00	Facility		$117.53	$796.00	$2,914.00
United Facility/Professional Professional Modifier Low / Median / High Price $63.60 / $108.80 / $259.00	Professional		$63.60	$108.80	$259.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.69 / $62.42 / $112.08	Professional	26	$37.69	$62.42	$112.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.63 / $43.40 / $159.93	Professional	TC	$26.63	$43.40	$159.93