Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $223.87 / $478.63	Facility		$48.98	$223.87	$478.63
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 $25.12 / $208.93 / $660.69	Facility	TC	$25.12	$208.93	$660.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $8.91 / $33.11 / $107.15	Professional		$8.91	$33.11	$107.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $14.45 / $48.98	Professional	26	$7.08	$14.45	$48.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.78 / $77.62 / $257.04	Professional	50	$17.78	$77.62	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $30.90 / $67.61	Professional	TC	$19.05	$30.90	$67.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $25.70 / $47.86	Professional		$20.89	$25.70	$47.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $7.41 / $12.88	Professional	26	$6.03	$7.41	$12.88
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $37.15 / $64.57 / $85.11	Professional	50	$37.15	$64.57	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $23.44 / $40.74	Professional	TC	$19.50	$23.44	$40.74
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 $25.70 / $33.88 / $54.95	Professional		$25.70	$33.88	$54.95
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.22 / $18.62	Professional	26	$8.71	$11.22	$18.62
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $38.90 / $51.29 / $83.18	Professional	50	$38.90	$51.29	$83.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $22.91 / $36.31	Professional	TC	$16.98	$22.91	$36.31
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $33.88 / $38.02 / $58.88	Professional		$33.88	$38.02	$58.88
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.77 / $15.14	Professional	26	$8.51	$9.77	$15.14
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $28.18 / $43.65	Professional	TC	$25.12	$28.18	$43.65
CareSource Facility/Professional Facility Modifier Low / Median / High Price $8.71 / $28.18 / $46.77	Facility		$8.71	$28.18	$46.77
CareSource Facility/Professional Professional Modifier Low / Median / High Price $7.94 / $26.30 / $45.71	Professional		$7.94	$26.30	$45.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $23.44 / $38.90 / $177.83	Facility		$23.44	$38.90	$177.83
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 $5.62 / $26.30 / $37.15	Facility	TC	$5.62	$26.30	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $36.31 / $67.61	Professional		$25.12	$36.31	$67.61
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 $17.78 / $26.30 / $50.12	Professional	TC	$17.78	$26.30	$50.12
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $218.78 / $354.81	Facility		$104.71	$218.78	$354.81
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 $5.37 / $28.84 / $363.08	Facility	TC	$5.37	$28.84	$363.08
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $34.67 / $64.57	Professional		$21.88	$34.67	$64.57
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $11.48 / $23.99	Professional	26	$6.92	$11.48	$23.99
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $25.70 / $50.12	Professional	TC	$17.78	$25.70	$50.12
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 $30.90 / $41.69 / $67.61	Professional		$30.90	$41.69	$67.61
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $11.48 / $17.38	Professional	26	$7.94	$11.48	$17.38
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $22.91 / $28.84 / $50.12	Professional	TC	$22.91	$28.84	$50.12
United Facility/Professional Facility Modifier Low / Median / High Price $8.91 / $66.07 / $208.93	Facility		$8.91	$66.07	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $30.90 / $52.48	Professional		$23.99	$30.90	$52.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $6.61 / $9.12 / $14.79	Professional	26	$6.61	$9.12	$14.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $21.88 / $38.02	Professional	TC	$16.22	$21.88	$38.02