Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.72 / $390.10 / $838.42	Facility		$95.72	$390.10	$838.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.74 / $37.43 / $96.07	Facility	26	$26.74	$37.43	$96.07
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $68.38 / $298.00 / $822.50	Facility	TC	$68.38	$298.00	$822.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.54 / $107.68 / $344.00	Professional		$79.54	$107.68	$344.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.19 / $40.10 / $105.49	Professional	26	$26.19	$40.10	$105.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $53.50 / $73.06 / $129.79	Professional	TC	$53.50	$73.06	$129.79
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $62.77 / $66.70 / $109.86	Professional		$62.77	$66.70	$109.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.65 / $27.55 / $44.65	Professional	26	$20.65	$27.55	$44.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $33.28 / $43.37 / $80.91	Professional	TC	$33.28	$43.37	$80.91
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 $80.80 / $99.83 / $156.30	Professional		$80.80	$99.83	$156.30
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.03 / $35.46 / $55.15	Professional	26	$29.03	$35.46	$55.15
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $51.77 / $63.18 / $97.64	Professional	TC	$51.77	$63.18	$97.64
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $92.59 / $102.01 / $143.60	Professional		$92.59	$102.01	$143.60
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $31.01 / $34.15 / $48.09	Professional	26	$31.01	$34.15	$48.09
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $61.60 / $67.86 / $95.53	Professional	TC	$61.60	$67.86	$95.53
CareSource Facility/Professional Facility Modifier Low / Median / High Price $28.65 / $62.64 / $105.93	Facility		$28.65	$62.64	$105.93
CareSource Facility/Professional Professional Modifier Low / Median / High Price $28.91 / $65.29 / $107.37	Professional		$28.91	$65.29	$107.37
Cigna Facility/Professional Facility Modifier Low / Median / High Price $143.08 / $224.24 / $406.24	Facility		$143.08	$224.24	$406.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.47 / $113.78 / $191.61	Professional		$78.47	$113.78	$191.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.96 / $37.17 / $58.68	Professional	26	$24.96	$37.17	$58.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.04 / $75.69 / $133.47	Professional	TC	$52.04	$75.69	$133.47
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $193.84 / $403.09 / $891.54	Facility		$193.84	$403.09	$891.54
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $197.12 / $244.93 / $950.75	Facility	TC	$197.12	$244.93	$950.75
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $73.84 / $109.86 / $197.14	Professional		$73.84	$109.86	$197.14
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $26.57 / $39.93 / $75.76	Professional	26	$26.57	$39.93	$75.76
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $52.76 / $75.59 / $141.91	Professional	TC	$52.76	$75.59	$141.91
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $81.81 / $132.19	Professional		$40.43	$81.81	$132.19
United Facility/Professional Professional Modifier Low / Median / High Price $76.36 / $101.12 / $161.25	Professional		$76.36	$101.12	$161.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.38 / $32.76 / $53.38	Professional	26	$24.38	$32.76	$53.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.03 / $68.44 / $109.22	Professional	TC	$50.03	$68.44	$109.22