Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $44.67 / $229.09 / $457.09	Facility		$44.67	$229.09	$457.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.41 / $9.55 / $14.45	Facility	26	$7.41	$9.55	$14.45
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $22.91 / $177.83 / $436.52	Facility	TC	$22.91	$177.83	$436.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.23 / $30.20 / $87.10	Professional		$10.23	$30.20	$87.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $13.18 / $38.90	Professional	26	$7.08	$13.18	$38.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $15.49 / $58.88 / $251.19	Professional	50	$15.49	$58.88	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $29.51 / $63.10	Professional	TC	$16.98	$29.51	$63.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $18.62 / $22.91 / $43.65	Professional		$18.62	$22.91	$43.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.59 / $13.80	Professional	26	$6.03	$7.59	$13.80
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $42.66 / $70.79 / $85.11	Professional	50	$42.66	$70.79	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $19.50 / $36.31	Professional	TC	$17.38	$19.50	$36.31
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $213.80 / $223.87	Facility		$190.55	$213.80	$223.87
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $33.11 / $52.48	Professional		$25.12	$33.11	$52.48
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $10.96 / $17.38	Professional	26	$8.51	$10.96	$17.38
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $38.02 / $50.12 / $79.43	Professional	50	$38.02	$50.12	$79.43
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $21.88 / $35.48	Professional	TC	$16.98	$21.88	$35.48
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $33.11 / $54.95	Professional		$30.90	$33.11	$54.95
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.33 / $15.14	Professional	26	$8.51	$9.33	$15.14
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $22.39 / $23.99 / $39.81	Professional	TC	$22.39	$23.99	$39.81
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.71 / $25.70 / $43.65	Facility		$8.71	$25.70	$43.65
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.94 / $23.99 / $42.66	Professional		$7.94	$23.99	$42.66
Cigna Facility/Professional Facility Modifier Low / Median / High Price $20.89 / $21.88 / $223.87	Facility		$20.89	$21.88	$223.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $5.01 / $23.44 / $33.88	Facility	TC	$5.01	$23.44	$33.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $35.48 / $61.66	Professional		$23.44	$35.48	$61.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.47 / $17.78	Professional	26	$6.92	$10.47	$17.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $25.12 / $44.67	Professional	TC	$16.98	$25.12	$44.67
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $229.09 / $363.08	Facility		$100.00	$229.09	$363.08
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $1.86 / $8.71 / $12.59	Facility	26	$1.86	$8.71	$12.59
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $4.79 / $25.70 / $257.04	Facility	TC	$4.79	$25.70	$257.04
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $33.88 / $64.57	Professional		$22.39	$33.88	$64.57
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $10.96 / $22.91	Professional	26	$6.92	$10.96	$22.91
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $25.12 / $46.77	Professional	TC	$16.22	$25.12	$46.77
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 $107.15 / $107.15 / $107.15	Facility		$107.15	$107.15	$107.15
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
SummaCare Facility/Professional Facility Modifier TC Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	TC	$107.15	$107.15	$107.15
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $37.15 / $63.10	Professional		$28.18	$37.15	$63.10
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $10.23 / $17.38	Professional	26	$7.94	$10.23	$17.38
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $20.42 / $26.92 / $45.71	Professional	TC	$20.42	$26.92	$45.71
United Facility/Professional Facility Modifier Low / Median / High Price $8.13 / $66.07 / $208.93	Facility		$8.13	$66.07	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $29.51 / $50.12	Professional		$22.39	$29.51	$50.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $8.71 / $15.49	Professional	26	$6.61	$8.71	$15.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.49 / $20.42 / $35.48	Professional	TC	$15.49	$20.42	$35.48