Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.98 / $158.25 / $376.12	Facility	26	$112.98	$158.25	$376.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $329.60 / $475.00 / $1,077.65	Professional		$329.60	$475.00	$1,077.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.41 / $152.52 / $389.90	Professional	26	$110.41	$152.52	$389.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $163.81 / $175.87 / $349.38	Professional	52	$163.81	$175.87	$349.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $216.62 / $335.00 / $780.67	Professional	TC	$216.62	$335.00	$780.67
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $222.32 / $249.35 / $337.35	Professional		$222.32	$249.35	$337.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $82.06 / $107.50 / $188.75	Professional	26	$82.06	$107.50	$188.75
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $603.97 / $603.97 / $603.97	Professional	52	$603.97	$603.97	$603.97
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $157.79 / $215.64 / $295.69	Professional	TC	$157.79	$215.64	$295.69
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.76 / $448.19 / $785.92	Professional		$380.76	$448.19	$785.92
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $117.94 / $131.57 / $235.51	Professional	26	$117.94	$131.57	$235.51
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $242.25 / $315.33 / $564.30	Professional	TC	$242.25	$315.33	$564.30
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $346.15 / $381.36 / $536.83	Professional		$346.15	$381.36	$536.83
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $121.04 / $133.35 / $187.72	Professional	26	$121.04	$133.35	$187.72
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $225.11 / $248.00 / $349.11	Professional	TC	$225.11	$248.00	$349.11
CareSource Facility/Professional Professional Modifier Low / Median / High Price $112.84 / $240.66 / $419.33	Professional		$112.84	$240.66	$419.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $111.95 / $123.88 / $123.88	Facility	26	$111.95	$123.88	$123.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.10 / $542.60 / $1,239.27	Professional		$309.10	$542.60	$1,239.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $94.31 / $147.91 / $245.59	Professional	26	$94.31	$147.91	$245.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $204.01 / $362.55 / $1,040.47	Professional	TC	$204.01	$362.55	$1,040.47
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $111.95 / $111.95 / $123.88	Facility	26	$111.95	$111.95	$123.88
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $294.77 / $523.55 / $1,207.49	Professional		$294.77	$523.55	$1,207.49
Medical Mutual of Ohio Facility/Professional Professional Modifier 22 Low / Median / High Price $225.06 / $225.06 / $225.06	Professional	22	$225.06	$225.06	$225.06
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $107.76 / $164.90 / $323.26	Professional	26	$107.76	$164.90	$323.26
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $209.85 / $357.57 / $956.56	Professional	TC	$209.85	$357.57	$956.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $99.93 / $212.75 / $381.71	Professional		$99.93	$212.75	$381.71
United Facility/Professional Professional Modifier Low / Median / High Price $322.69 / $445.62 / $998.79	Professional		$322.69	$445.62	$998.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.19 / $123.75 / $227.00	Professional	26	$93.19	$123.75	$227.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $216.86 / $295.22 / $797.84	Professional	TC	$216.86	$295.22	$797.84