Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.26 / $392.04 / $822.50	Facility		$98.26	$392.04	$822.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.74 / $42.59 / $176.28	Facility	26	$25.74	$42.59	$176.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $101.33 / $137.83 / $358.21	Professional		$101.33	$137.83	$358.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.48 / $37.28 / $94.49	Professional	26	$24.48	$37.28	$94.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.99 / $51.10 / $96.12	Professional	52	$45.99	$51.10	$96.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.13 / $94.28 / $162.10	Professional	TC	$75.13	$94.28	$162.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $78.77 / $83.69 / $137.84	Professional		$78.77	$83.69	$137.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.88 / $26.52 / $41.94	Professional	26	$19.88	$26.52	$41.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $60.64 / $65.29 / $113.40	Professional	TC	$60.64	$65.29	$113.40
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 $81.14 / $104.36 / $167.39	Professional		$81.14	$104.36	$167.39
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.00 / $33.60 / $51.98	Professional	26	$28.00	$33.60	$51.98
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.14 / $68.93 / $115.99	Professional	TC	$53.14	$68.93	$115.99
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $116.18 / $128.00 / $128.97	Professional		$116.18	$128.00	$128.97
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $29.85 / $32.89 / $33.14	Professional	26	$29.85	$32.89	$33.14
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $86.33 / $95.11 / $95.84	Professional	TC	$86.33	$95.11	$95.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $27.58 / $87.79 / $132.91	Facility		$27.58	$87.79	$132.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $27.83 / $91.49 / $134.41	Professional		$27.83	$91.49	$134.41
Cigna Facility/Professional Facility Modifier Low / Median / High Price $171.20 / $264.47 / $528.41	Facility		$171.20	$264.47	$528.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.72 / $135.88 / $227.37	Professional		$92.72	$135.88	$227.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $35.82 / $56.52	Professional	26	$24.15	$35.82	$56.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.54 / $100.96 / $171.82	Professional	TC	$67.54	$100.96	$171.82
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $228.04 / $412.17 / $830.03	Facility		$228.04	$412.17	$830.03
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $93.41 / $132.93 / $226.47	Professional		$93.41	$132.93	$226.47
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $25.69 / $38.44 / $72.00	Professional	26	$25.69	$38.44	$72.00
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $70.92 / $102.97 / $175.27	Professional	TC	$70.92	$102.97	$175.27
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $86.99 / $175.61	Professional		$40.43	$86.99	$175.61
United Facility/Professional Facility Modifier Low / Median / High Price $31.63 / $80.87 / $203.83	Facility		$31.63	$80.87	$203.83
United Facility/Professional Professional Modifier Low / Median / High Price $86.15 / $124.23 / $214.94	Professional		$86.15	$124.23	$214.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.48 / $31.39 / $50.28	Professional	26	$23.48	$31.39	$50.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.67 / $92.02 / $148.38	Professional	TC	$61.67	$92.02	$148.38