Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $229.09 / $602.56	Facility		$38.02	$229.09	$602.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.13 / $10.72 / $15.85	Facility	26	$8.13	$10.72	$15.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $18.20 / $53.70 / $501.19	Facility	TC	$18.20	$53.70	$501.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $37.15 / $104.71	Professional		$22.91	$37.15	$104.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $11.22 / $30.20	Professional	26	$7.76	$11.22	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $25.12 / $66.07	Professional	TC	$15.14	$25.12	$66.07
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $22.91 / $40.74	Professional		$17.78	$22.91	$40.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $8.32 / $14.79	Professional	26	$6.46	$8.32	$14.79
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $18.20 / $38.02	Professional	TC	$15.49	$18.20	$38.02
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $288.40 / $302.00	Facility		$257.04	$288.40	$302.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $33.11 / $52.48	Professional		$24.55	$33.11	$52.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.48 / $19.05	Professional	26	$8.71	$11.48	$19.05
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $20.89 / $33.88	Professional	TC	$15.85	$20.89	$33.88
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $33.88 / $52.48	Professional		$30.20	$33.88	$52.48
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $10.72 / $16.60	Professional	26	$9.33	$10.72	$16.60
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $23.44 / $36.31	Professional	TC	$20.42	$23.44	$36.31
CareSource Facility/Professional Facility Modifier Low / Median / High Price $9.33 / $23.44 / $41.69	Facility		$9.33	$23.44	$41.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $8.71 / $21.88 / $39.81	Professional		$8.71	$21.88	$39.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.50 / $323.59	Facility		$19.05	$19.50	$323.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $4.57 / $21.38 / $30.20	Facility	TC	$4.57	$21.38	$30.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $36.31 / $60.26	Professional		$23.44	$36.31	$60.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.22 / $19.05	Professional	26	$7.59	$11.22	$19.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $23.99 / $42.66	Professional	TC	$15.85	$23.99	$42.66
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $218.78 / $363.08	Facility		$91.20	$218.78	$363.08
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $2.04 / $9.55 / $13.49	Facility	26	$2.04	$9.55	$13.49
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $4.37 / $23.44 / $295.12	Facility	TC	$4.37	$23.44	$295.12
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $33.88 / $63.10	Professional		$21.88	$33.88	$63.10
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $7.59 / $11.48 / $24.55	Professional	26	$7.59	$11.48	$24.55
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $23.44 / $45.71	Professional	TC	$15.49	$23.44	$45.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.49 / $32.36 / $33.11	Professional		$13.49	$32.36	$33.11
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Facility Modifier TC Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	TC	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $27.54 / $34.67 / $61.66	Professional		$27.54	$34.67	$61.66
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.72 / $19.05	Professional	26	$8.51	$10.72	$19.05
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $23.99 / $41.69	Professional	TC	$19.05	$23.99	$41.69
United Facility/Professional Facility Modifier Low / Median / High Price $8.91 / $81.28 / $251.19	Facility		$8.91	$81.28	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $29.51 / $51.29	Professional		$22.39	$29.51	$51.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $9.55 / $16.22	Professional	26	$6.92	$9.55	$16.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $19.95 / $35.48	Professional	TC	$15.14	$19.95	$35.48