Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $323.59 / $831.76	Facility		$138.04	$323.59	$831.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $34.67 / $50.12	Facility	26	$25.70	$34.67	$50.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $117.49 / $263.03	Professional		$72.44	$117.49	$263.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $39.81 / $87.10	Professional	26	$23.99	$39.81	$87.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $83.18 / $173.78	Professional	TC	$50.12	$83.18	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $95.50 / $125.89	Professional		$79.43	$95.50	$125.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $26.92 / $40.74	Professional	26	$19.50	$26.92	$40.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $87.10 / $162.18	Professional		$63.10	$87.10	$162.18
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $33.11 / $52.48	Professional	26	$26.92	$33.11	$52.48
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $52.48 / $117.49	Professional	TC	$35.48	$52.48	$117.49
CareSource Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $93.33 / $138.04	Facility		$28.18	$93.33	$138.04
CareSource Facility/Professional Professional Modifier Low / Median / High Price $31.62 / $104.71 / $208.93	Professional		$31.62	$104.71	$208.93
Cigna Facility/Professional Facility Modifier Low / Median / High Price $38.90 / $95.50 / $316.23	Facility		$38.90	$95.50	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $125.89 / $213.80	Professional		$89.13	$125.89	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $34.67 / $58.88	Professional	26	$25.12	$34.67	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $91.20 / $158.49	Professional	TC	$61.66	$91.20	$158.49
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $173.78 / $380.19 / $812.83	Facility		$173.78	$380.19	$812.83
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $120.23 / $213.80	Professional		$79.43	$120.23	$213.80
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $34.67 / $58.88	Professional	26	$25.12	$34.67	$58.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $93.33 / $162.18	Professional	TC	$61.66	$93.33	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $138.04 / $223.87	Professional		$102.33	$138.04	$223.87
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $33.88 / $52.48	Professional	26	$27.54	$33.88	$52.48
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $104.71 / $169.82	Professional	TC	$64.57	$104.71	$169.82
United Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $102.33 / $144.54	Professional		$66.07	$102.33	$144.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $28.18 / $39.81	Professional	26	$19.95	$28.18	$39.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $74.13 / $104.71	Professional	TC	$42.66	$74.13	$104.71