Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $1,202.26 / $9,549.93	Facility		$218.78	$1,202.26	$9,549.93
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $60.26 / $131.83	Facility	26	$38.90	$60.26	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $234.42 / $891.25	Professional		$147.91	$234.42	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $52.48 / $107.15	Professional	26	$37.15	$52.48	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $158.49 / $275.42	Professional	TC	$91.20	$158.49	$275.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $158.49 / $251.19	Professional		$107.15	$158.49	$251.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $38.90 / $38.90	Professional	26	$38.90	$38.90	$38.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	TC	$134.90	$134.90	$134.90
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $2,137.96 / $2,511.89	Facility		$1,905.46	$2,137.96	$2,511.89
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $251.19 / $416.87	Professional		$144.54	$251.19	$416.87
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $77.62 / $125.89	Professional	26	$44.67	$77.62	$125.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $186.21 / $295.12	Professional	TC	$83.18	$186.21	$295.12
CareSource Facility/Professional Facility Modifier Low / Median / High Price $41.69 / $134.90 / $199.53	Facility		$41.69	$134.90	$199.53
CareSource Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $151.36 / $302.00	Professional		$47.86	$151.36	$302.00
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 $147.91 / $208.93 / $380.19	Professional		$147.91	$208.93	$380.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $95.50	Professional	26	$39.81	$57.54	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $147.91 / $257.04	Professional	TC	$100.00	$147.91	$257.04
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $389.05 / $467.74	Facility		$190.55	$389.05	$467.74
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $208.93 / $363.08	Professional		$147.91	$208.93	$363.08
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $95.50	Professional	26	$39.81	$57.54	$95.50
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $144.54 / $263.03	Professional	TC	$107.15	$144.54	$263.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $39.81	Professional		$32.36	$33.11	$39.81
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $100.00 / $100.00	Facility		$100.00	$100.00	$100.00
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $186.21 / $338.84	Professional		$151.36	$186.21	$338.84
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $50.12 / $95.50	Professional	26	$40.74	$50.12	$95.50
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $138.04 / $245.47	Professional	TC	$109.65	$138.04	$245.47
United Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $954.99 / $3,019.95	Facility		$457.09	$954.99	$3,019.95
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $186.21 / $316.23	Professional		$123.03	$186.21	$316.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $51.29 / $87.10	Professional	26	$35.48	$51.29	$87.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $138.04 / $229.09	Professional	TC	$81.28	$138.04	$229.09