Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.48 / $341.25 / $952.08	Facility		$108.48	$341.25	$952.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.83 / $52.67 / $133.00	Facility	26	$36.83	$52.67	$133.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.66 / $136.33 / $505.50	Professional		$105.66	$136.33	$505.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $48.71 / $138.38	Professional	26	$34.67	$48.71	$138.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.09 / $91.86 / $169.09	Professional	TC	$70.09	$91.86	$169.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $67.38 / $93.11 / $109.54	Professional		$67.38	$93.11	$109.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.49 / $37.53 / $59.81	Professional	26	$28.49	$37.53	$59.81
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $56.73 / $65.84 / $106.08	Professional	TC	$56.73	$65.84	$106.08
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 $112.08 / $135.80 / $211.76	Professional		$112.08	$135.80	$211.76
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.64 / $49.36 / $77.20	Professional	26	$40.64	$49.36	$77.20
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.44 / $85.24 / $131.37	Professional	TC	$71.44	$85.24	$131.37
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $123.35 / $123.35 / $135.88	Professional		$123.35	$123.35	$135.88
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $42.57 / $42.57 / $46.90	Professional	26	$42.57	$42.57	$46.90
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $80.76 / $80.76 / $88.97	Professional	TC	$80.76	$80.76	$88.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.33 / $82.13 / $141.12	Facility		$39.33	$82.13	$141.12
CareSource Facility/Professional Professional Modifier Low / Median / High Price $39.69 / $86.56 / $143.04	Professional		$39.69	$86.56	$143.04
Cigna Facility/Professional Facility Modifier Low / Median / High Price $171.20 / $264.75 / $528.41	Facility		$171.20	$264.75	$528.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.53 / $154.63 / $256.11	Professional		$104.53	$154.63	$256.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.26 / $51.20 / $81.23	Professional	26	$35.26	$51.20	$81.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.92 / $102.25 / $173.82	Professional	TC	$68.92	$102.25	$173.82
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $224.24 / $409.44 / $1,083.42	Facility		$224.24	$409.44	$1,083.42
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $103.82 / $148.68 / $256.11	Professional		$103.82	$148.68	$256.11
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $37.40 / $53.68 / $89.16	Professional	26	$37.40	$53.68	$89.16
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $99.98 / $180.39	Professional	TC	$69.65	$99.98	$180.39
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $88.08 / $175.61	Professional		$40.43	$88.08	$175.61
United Facility/Professional Professional Modifier Low / Median / High Price $101.07 / $135.32 / $213.38	Professional		$101.07	$135.32	$213.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $46.05 / $72.95	Professional	26	$34.06	$46.05	$72.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.33 / $90.47 / $141.15	Professional	TC	$67.33	$90.47	$141.15