Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $52.15 / $178.64 / $470.03	Facility		$52.15	$178.64	$470.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.40 / $15.55 / $36.97	Facility	26	$10.40	$15.55	$36.97
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $34.08 / $133.27 / $407.02	Facility	TC	$34.08	$133.27	$407.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.20 / $41.67 / $81.43	Professional		$34.20	$41.67	$81.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.59 / $11.45 / $25.43	Professional	26	$9.59	$11.45	$25.43
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	50	$38.29	$38.29	$38.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.49 / $28.50 / $53.64	Professional	TC	$24.49	$28.50	$53.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $26.91 / $32.49 / $57.74	Professional		$26.91	$32.49	$57.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $9.09 / $17.23	Professional	26	$8.08	$9.09	$17.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.93 / $27.69 / $27.69	Professional	TC	$26.93	$27.69	$27.69
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $246.06 / $260.52 / $297.37	Facility		$246.06	$260.52	$297.37
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.02 / $45.04 / $74.91	Professional		$37.02	$45.04	$74.91
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $11.29 / $13.16 / $23.00	Professional	26	$11.29	$13.16	$23.00
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $55.53 / $67.23 / $112.36	Professional	50	$55.53	$67.23	$112.36
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $25.54 / $31.47 / $52.92	Professional	TC	$25.54	$31.47	$52.92
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $48.43 / $48.43 / $48.43	Professional		$48.43	$48.43	$48.43
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $13.13 / $13.13 / $13.13	Professional	26	$13.13	$13.13	$13.13
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $35.29 / $35.29 / $35.29	Professional	TC	$35.29	$35.29	$35.29
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.11 / $32.58 / $50.29	Facility		$11.11	$32.58	$50.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $11.11 / $34.13 / $52.15	Professional		$11.11	$34.13	$52.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.23 / $224.24 / $405.20	Facility		$46.23	$224.24	$405.20
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 $29.45 / $34.29 / $34.29	Facility	TC	$29.45	$34.29	$34.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.17 / $51.41 / $87.27	Professional		$34.17	$51.41	$87.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.43 / $14.46 / $24.38	Professional	26	$9.43	$14.46	$24.38
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $49.64 / $49.64 / $49.64	Professional	50	$49.64	$49.64	$49.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.35 / $36.20 / $63.60	Professional	TC	$24.35	$36.20	$63.60
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $99.09 / $264.75 / $418.26	Facility		$99.09	$264.75	$418.26
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 $29.45 / $287.22 / $360.86	Facility	TC	$29.45	$287.22	$360.86
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $34.74 / $49.89 / $79.48	Professional		$34.74	$49.89	$79.48
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $10.25 / $15.00 / $25.06	Professional	26	$10.25	$15.00	$25.06
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $25.14 / $36.20 / $60.82	Professional	TC	$25.14	$36.20	$60.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.52 / $36.24 / $51.07	Professional		$26.52	$36.24	$51.07
United Facility/Professional Professional Modifier Low / Median / High Price $34.11 / $43.88 / $76.37	Professional		$34.11	$43.88	$76.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.40 / $13.12 / $23.10	Professional	26	$9.40	$13.12	$23.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.57 / $31.03 / $54.85	Professional	TC	$23.57	$31.03	$54.85