Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $63.06 / $225.60 / $458.24	Facility		$63.06	$225.60	$458.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.40 / $17.20 / $308.20	Facility	26	$10.40	$17.20	$308.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $44.96 / $215.26 / $591.26	Facility	TC	$44.96	$215.26	$591.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $13.82 / $44.10 / $92.61	Professional		$13.82	$44.10	$92.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $14.19 / $29.58	Professional	26	$9.65	$14.19	$29.58
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $53.01 / $63.46 / $63.46	Professional	50	$53.01	$63.46	$63.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $36.34 / $69.98	Professional	TC	$27.55	$36.34	$69.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $30.96 / $38.42 / $60.00	Professional		$30.96	$38.42	$60.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.97 / $12.12 / $17.68	Professional	26	$7.97	$12.12	$17.68
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $27.14 / $33.40 / $50.76	Professional	TC	$27.14	$33.40	$50.76
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $182.82 / $193.56 / $220.94	Facility		$182.82	$193.56	$220.94
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.58 / $47.77 / $79.19	Professional		$38.58	$47.77	$79.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.94 / $12.88 / $22.34	Professional	26	$9.94	$12.88	$22.34
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $56.83 / $70.70 / $118.79	Professional	50	$56.83	$70.70	$118.79
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $27.51 / $35.14 / $56.97	Professional	TC	$27.51	$35.14	$56.97
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $50.56 / $50.56 / $50.56	Professional		$50.56	$50.56	$50.56
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $11.92 / $11.92 / $11.92	Professional	26	$11.92	$11.92	$11.92
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $38.65 / $38.65 / $38.65	Professional	TC	$38.65	$38.65	$38.65
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.11 / $39.29 / $57.85	Facility		$11.11	$39.29	$57.85
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.11 / $41.20 / $59.99	Professional		$11.11	$41.20	$59.99
Cigna Facility/Professional Facility Modifier Low / Median / High Price $53.31 / $173.99 / $268.55	Facility		$53.31	$173.99	$268.55
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $13.25	Facility	26	$12.30	$12.30	$13.25
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $34.52 / $41.38 / $41.38	Facility	TC	$34.52	$41.38	$41.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.36 / $55.03 / $98.56	Professional		$38.36	$55.03	$98.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.43 / $14.32 / $24.28	Professional	26	$9.43	$14.32	$24.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.52 / $40.57 / $75.31	Professional	TC	$28.52	$40.57	$75.31
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $120.18 / $237.72 / $444.62	Facility		$120.18	$237.72	$444.62
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $12.30 / $12.30 / $13.25	Facility	26	$12.30	$12.30	$13.25
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $34.52 / $191.10 / $539.45	Facility	TC	$34.52	$191.10	$539.45
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $37.97 / $54.74 / $107.00	Professional		$37.97	$54.74	$107.00
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $10.41 / $15.46 / $32.21	Professional	26	$10.41	$15.46	$32.21
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $29.85 / $41.45 / $68.77	Professional	TC	$29.85	$41.45	$68.77
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.07 / $35.10 / $50.16	Professional		$26.07	$35.10	$50.16
United Facility/Professional Professional Modifier Low / Median / High Price $36.01 / $47.98 / $86.88	Professional		$36.01	$47.98	$86.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.18 / $12.80 / $22.44	Professional	26	$9.18	$12.80	$22.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.65 / $36.51 / $63.61	Professional	TC	$26.65	$36.51	$63.61