Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $288.40 / $1,621.81	Facility		$141.25	$288.40	$1,621.81
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $112.20 / $281.84	Facility	26	$79.43	$112.20	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $181.97 / $478.63	Professional		$125.89	$181.97	$478.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $83.18 / $199.53	Professional	26	$51.29	$83.18	$199.53
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.89 / $125.89 / $134.90	Professional	52	$125.89	$125.89	$134.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $57.54 / $87.10 / $331.13	Professional	TC	$57.54	$87.10	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $123.03	Professional		$114.82	$114.82	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $77.62 / $144.54	Professional	26	$64.57	$77.62	$144.54
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $346.74 / $549.54	Professional		$194.98	$346.74	$549.54
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $81.28 / $131.83	Professional	26	$58.88	$81.28	$131.83
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $245.47 / $426.58	Professional	TC	$91.20	$245.47	$426.58
CareSource Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $109.65 / $229.09	Facility		$64.57	$109.65	$229.09
CareSource Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $104.71 / $199.53	Professional		$66.07	$104.71	$199.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $69.18 / $9,332.54	Facility		$66.07	$69.18	$9,332.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $245.47 / $741.31	Professional		$138.04	$245.47	$741.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $91.20 / $169.82	Professional	26	$58.88	$91.20	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $117.49 / $457.09	Professional	TC	$61.66	$117.49	$457.09
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $3,981.07 / $9,120.11	Facility		$234.42	$3,981.07	$9,120.11
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $213.80 / $630.96	Professional		$123.03	$213.80	$630.96
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $91.20 / $169.82	Professional	26	$57.54	$91.20	$169.82
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $109.65 / $501.19	Professional	TC	$58.88	$109.65	$501.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $45.71	Professional		$32.36	$33.11	$45.71
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $3,890.45 / $3,890.45 / $3,890.45	Facility		$3,890.45	$3,890.45	$3,890.45
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $3,890.45 / $3,890.45 / $3,890.45	Facility	26	$3,890.45	$3,890.45	$3,890.45
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $331.13	Professional		$147.91	$186.21	$331.13
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $100.00 / $186.21	Professional	26	$83.18	$100.00	$186.21
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $83.18 / $177.83	Professional	TC	$66.07	$83.18	$177.83
United Facility/Professional Facility Modifier Low / Median / High Price $58.88 / $2,398.83 / $7,585.78	Facility		$58.88	$2,398.83	$7,585.78
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $199.53 / $512.86	Professional		$134.90	$199.53	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $85.11 / $144.54	Professional	26	$53.70	$85.11	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $93.33 / $398.11	Professional	TC	$63.10	$93.33	$398.11