Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $309.03 / $645.65	Facility		$83.18	$309.03	$645.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $42.66 / $112.20	Facility	26	$31.62	$42.66	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $97.72 / $338.84	Professional		$48.98	$97.72	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $61.66 / $158.49	Professional	26	$30.20	$61.66	$158.49
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $67.61 / $173.78 / $645.65	Professional	50	$67.61	$173.78	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $60.26 / $173.78	Professional	TC	$42.66	$60.26	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $74.13 / $87.10	Professional		$61.66	$74.13	$87.10
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.90 / $56.23	Professional	26	$25.70	$38.90	$56.23
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $83.18 / $93.33 / $123.03	Professional	50	$83.18	$93.33	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $43.65 / $50.12	Professional	TC	$36.31	$43.65	$50.12
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 $83.18 / $104.71 / $162.18	Professional		$83.18	$104.71	$162.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $41.69 / $64.57	Professional	26	$33.11	$41.69	$64.57
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $125.89 / $154.88 / $239.88	Professional	50	$125.89	$154.88	$239.88
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $63.10 / $97.72	Professional	TC	$50.12	$63.10	$97.72
Aultcare Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $102.33 / $102.33	Facility		$102.33	$102.33	$102.33
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $95.50 / $158.49	Professional		$91.20	$95.50	$158.49
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $38.02 / $61.66	Professional	26	$36.31	$38.02	$61.66
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $58.88 / $95.50	Professional	TC	$54.95	$58.88	$95.50
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $61.66 / $125.89	Facility		$34.67	$61.66	$125.89
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $56.23 / $104.71	Professional		$33.11	$56.23	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $51.29 / $51.29 / $275.42	Facility		$51.29	$51.29	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $107.15 / $169.82	Professional		$72.44	$107.15	$169.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $42.66 / $69.18	Professional	26	$28.84	$42.66	$69.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $66.07 / $104.71	Professional	TC	$44.67	$66.07	$104.71
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $288.40 / $616.60	Facility		$134.90	$288.40	$616.60
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $104.71 / $177.83	Professional		$69.18	$104.71	$177.83
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $44.67 / $81.28	Professional	26	$28.84	$44.67	$81.28
Medical Mutual of Ohio Facility/Professional Professional Modifier 50 Low / Median / High Price $47.86 / $87.10 / $102.33	Professional	50	$47.86	$87.10	$102.33
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $64.57 / $107.15	Professional	TC	$43.65	$64.57	$107.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $33.11 / $43.65	Professional		$29.51	$33.11	$43.65
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $107.15 / $125.89	Facility		$107.15	$107.15	$125.89
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $50.12 / $107.15	Facility	26	$50.12	$50.12	$107.15
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $104.71 / $181.97	Professional		$83.18	$104.71	$181.97
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $41.69 / $70.79	Professional	26	$32.36	$41.69	$70.79
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $63.10 / $109.65	Professional	TC	$50.12	$63.10	$109.65
United Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $66.07 / $251.19	Facility		$36.31	$66.07	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $91.20 / $147.91	Professional		$69.18	$91.20	$147.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $37.15 / $58.88	Professional	26	$27.54	$37.15	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $54.95 / $89.13	Professional	TC	$41.69	$54.95	$89.13