Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $39.11 / $115.02 / $385.03	Facility		$39.11	$115.02	$385.03
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.19 / $32.43 / $92.87	Facility	26	$25.19	$32.43	$92.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.11 / $77.33 / $124.52	Professional		$39.11	$77.33	$124.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.19 / $34.99 / $66.31	Professional	26	$25.19	$34.99	$66.31
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $56.53 / $56.53 / $334.86	Professional	50	$56.53	$56.53	$334.86
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $19.55 / $23.58 / $45.00	Professional	52	$19.55	$23.58	$45.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.91 / $23.94 / $71.00	Professional	TC	$13.91	$23.94	$71.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $40.35 / $40.35 / $59.04	Professional		$40.35	$40.35	$59.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.62 / $25.62 / $25.62	Professional	26	$25.62	$25.62	$25.62
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $14.72 / $14.72 / $14.72	Professional	TC	$14.72	$14.72	$14.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.43 / $82.96 / $144.44	Professional		$56.43	$82.96	$144.44
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.99 / $30.32 / $51.97	Professional	26	$21.99	$30.32	$51.97
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $84.64 / $124.44 / $216.68	Professional	50	$84.64	$124.44	$216.68
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $22.42 / $53.93 / $94.12	Professional	TC	$22.42	$53.93	$94.12
CareSource Facility/Professional Facility Modifier Low / Median / High Price $16.23 / $33.38 / $58.29	Facility		$16.23	$33.38	$58.29
CareSource Facility/Professional Professional Modifier Low / Median / High Price $16.89 / $35.63 / $60.44	Professional		$16.89	$35.63	$60.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.34 / $79.72 / $145.51	Professional		$45.34	$79.72	$145.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.05 / $38.49 / $57.03	Professional	26	$24.05	$38.49	$57.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.37 / $37.65 / $90.08	Professional	TC	$16.37	$37.65	$90.08
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $86.88 / $174.40 / $247.00	Facility		$86.88	$174.40	$247.00
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $45.50 / $71.25 / $143.09	Professional		$45.50	$71.25	$143.09
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $26.15 / $38.95 / $56.80	Professional	26	$26.15	$38.95	$56.80
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $17.14 / $31.49 / $91.16	Professional	TC	$17.14	$31.49	$91.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.44 / $47.67 / $87.55	Professional		$29.44	$47.67	$87.55
United Facility/Professional Professional Modifier Low / Median / High Price $50.95 / $70.05 / $123.15	Professional		$50.95	$70.05	$123.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $32.83 / $61.84	Professional	26	$23.99	$32.83	$61.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.04 / $36.52 / $74.84	Professional	TC	$23.04	$36.52	$74.84