Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $204.92 / $864.02 / $8,956.00	Facility		$204.92	$864.02	$8,956.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.32 / $66.84 / $133.09	Facility	26	$39.32	$66.84	$133.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $152.68 / $226.35 / $432.74	Professional		$152.68	$226.35	$432.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.32 / $47.98 / $88.32	Professional	26	$39.32	$47.98	$88.32
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.87 / $150.08 / $266.64	Professional	TC	$108.87	$150.08	$266.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $152.31 / $152.31 / $179.19	Professional		$152.31	$152.31	$179.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.18 / $48.18 / $48.18	Professional	26	$48.18	$48.18	$48.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.43 / $95.43 / $95.43	Professional	TC	$95.43	$95.43	$95.43
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $937.00 / $2,059.00 / $2,412.00	Facility		$937.00	$2,059.00	$2,412.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $139.72 / $246.82 / $439.79	Professional		$139.72	$246.82	$439.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.39 / $77.17 / $125.92	Professional	26	$47.39	$77.17	$125.92
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.83 / $183.15 / $304.30	Professional	TC	$76.83	$183.15	$304.30
CareSource Facility/Professional Facility Modifier Low / Median / High Price $40.77 / $134.72 / $201.60	Facility		$40.77	$134.72	$201.60
CareSource Facility/Professional Professional Modifier Low / Median / High Price $47.39 / $145.94 / $245.93	Professional		$47.39	$145.94	$245.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $21,571.00 / $21,571.00 / $21,571.00	Facility		$21,571.00	$21,571.00	$21,571.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.33 / $209.06 / $374.78	Professional		$149.33	$209.06	$374.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.76 / $58.55 / $112.59	Professional	26	$40.76	$58.55	$112.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $108.23 / $146.41 / $284.33	Professional	TC	$108.23	$146.41	$284.33
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $182.21 / $293.11 / $485.21	Facility		$182.21	$293.11	$485.21
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $147.46 / $210.52 / $401.10	Professional		$147.46	$210.52	$401.10
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $40.76 / $58.01 / $112.59	Professional	26	$40.76	$58.01	$112.59
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $108.73 / $146.46 / $284.33	Professional	TC	$108.73	$146.46	$284.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $41.14 / $158.98 / $240.59	Professional		$41.14	$158.98	$240.59
United Facility/Professional Facility Modifier Low / Median / High Price $444.00 / $979.00 / $3,218.00	Facility		$444.00	$979.00	$3,218.00
United Facility/Professional Professional Modifier Low / Median / High Price $136.47 / $199.64 / $398.77	Professional		$136.47	$199.64	$398.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.60 / $52.33 / $89.75	Professional	26	$38.60	$52.33	$89.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.19 / $150.44 / $241.79	Professional	TC	$87.19	$150.44	$241.79