Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $387.66 / $554.35 / $1,374.02	Facility	26	$387.66	$554.35	$1,374.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,637.05 / $2,215.73 / $5,606.73	Professional		$1,637.05	$2,215.73	$5,606.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $368.80 / $533.89 / $1,010.10	Professional	26	$368.80	$533.89	$1,010.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,249.39 / $1,773.34 / $3,742.57	Professional	TC	$1,249.39	$1,773.34	$3,742.57
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,197.78 / $1,330.86 / $1,885.98	Professional		$1,197.78	$1,330.86	$1,885.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $319.10 / $423.81 / $598.32	Professional	26	$319.10	$423.81	$598.32
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,457.46 / $1,917.05 / $2,812.89	Professional		$1,457.46	$1,917.05	$2,812.89
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $412.33 / $507.16 / $839.11	Professional	26	$412.33	$507.16	$839.11
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,045.13 / $1,390.02 / $2,102.26	Professional	TC	$1,045.13	$1,390.02	$2,102.26
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $1,963.02 / $1,963.02 / $1,963.02	Professional		$1,963.02	$1,963.02	$1,963.02
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $470.68 / $470.68 / $470.68	Professional	26	$470.68	$470.68	$470.68
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $1,492.35 / $1,492.35 / $1,492.35	Professional	TC	$1,492.35	$1,492.35	$1,492.35
CareSource Facility/Professional Professional Modifier Low / Median / High Price $474.28 / $1,591.80 / $2,501.78	Professional		$474.28	$1,591.80	$2,501.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $657.55 / $657.55 / $657.55	Facility	26	$657.55	$657.55	$657.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,641.26 / $2,340.08 / $4,126.89	Professional		$1,641.26	$2,340.08	$4,126.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $396.20 / $546.19 / $960.10	Professional	26	$396.20	$546.19	$960.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,274.52 / $1,792.52 / $3,264.01	Professional	TC	$1,274.52	$1,792.52	$3,264.01
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $657.55 / $657.55 / $657.55	Facility	26	$657.55	$657.55	$657.55
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $1,623.10 / $2,329.01 / $4,551.70	Professional		$1,623.10	$2,329.01	$4,551.70
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $403.62 / $558.42 / $1,025.28	Professional	26	$403.62	$558.42	$1,025.28
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $1,319.49 / $1,773.24 / $2,951.98	Professional	TC	$1,319.49	$1,773.24	$2,951.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $416.19 / $1,560.69 / $2,480.56	Professional		$416.19	$1,560.69	$2,480.56
United Facility/Professional Professional Modifier Low / Median / High Price $1,333.40 / $2,105.14 / $3,541.81	Professional		$1,333.40	$2,105.14	$3,541.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $301.27 / $456.16 / $814.79	Professional	26	$301.27	$456.16	$814.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,069.78 / $1,665.34 / $2,716.77	Professional	TC	$1,069.78	$1,665.34	$2,716.77