Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $98.26 / $275.89 / $920.26	Facility		$98.26	$275.89	$920.26
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.89 / $47.44 / $121.49	Facility	26	$33.89	$47.44	$121.49
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $75.77 / $226.41 / $883.60	Facility	TC	$75.77	$226.41	$883.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.09 / $133.18 / $504.52	Professional		$99.09	$133.18	$504.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.68 / $45.75 / $130.41	Professional	26	$31.68	$45.75	$130.41
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $44.97 / $50.48 / $105.47	Professional	52	$44.97	$50.48	$105.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.95 / $87.95 / $165.28	Professional	TC	$65.95	$87.95	$165.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $74.06 / $82.92 / $112.18	Professional		$74.06	$82.92	$112.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.85 / $34.25 / $55.92	Professional	26	$25.85	$34.25	$55.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.55 / $62.15 / $100.15	Professional	TC	$53.55	$62.15	$100.15
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 $105.49 / $127.51 / $201.59	Professional		$105.49	$127.51	$201.59
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.38 / $44.74 / $69.03	Professional	26	$36.38	$44.74	$69.03
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.11 / $82.52 / $130.54	Professional	TC	$69.11	$82.52	$130.54
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $115.11 / $126.82 / $127.79	Professional		$115.11	$126.82	$127.79
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $42.81 / $43.14	Professional	26	$38.86	$42.81	$43.14
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $76.23 / $83.99 / $84.64	Professional	TC	$76.23	$83.99	$84.64
CareSource Facility/Professional Facility Modifier Low / Median / High Price $35.89 / $77.53 / $131.69	Facility		$35.89	$77.53	$131.69
CareSource Facility/Professional Professional Modifier Low / Median / High Price $36.22 / $81.29 / $133.44	Professional		$36.22	$81.29	$133.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $171.20 / $264.75 / $501.61	Facility		$171.20	$264.75	$501.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.55 / $143.22 / $237.23	Professional		$97.55	$143.22	$237.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.29 / $46.35 / $73.77	Professional	26	$31.29	$46.35	$73.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.61 / $95.41 / $166.50	Professional	TC	$64.61	$95.41	$166.50
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $218.77 / $421.01 / $986.15	Facility		$218.77	$421.01	$986.15
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $198.02 / $245.86 / $1,031.14	Facility	TC	$198.02	$245.86	$1,031.14
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $95.60 / $137.72 / $241.55	Professional		$95.60	$137.72	$241.55
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $33.57 / $49.82 / $93.74	Professional	26	$33.57	$49.82	$93.74
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $65.36 / $93.69 / $175.89	Professional	TC	$65.36	$93.69	$175.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.44 / $82.38 / $133.56	Professional		$40.44	$82.38	$133.56
United Facility/Professional Professional Modifier Low / Median / High Price $93.79 / $126.36 / $198.87	Professional		$93.79	$126.36	$198.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.12 / $41.28 / $66.45	Professional	26	$30.12	$41.28	$66.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.08 / $84.50 / $132.11	Professional	TC	$62.08	$84.50	$132.11