Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $20.77 / $121.51 / $231.97	Facility		$20.77	$121.51	$231.97
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $2.57 / $4.54 / $10.00	Facility	26	$2.57	$4.54	$10.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $18.88 / $29.81 / $53.95	Professional		$18.88	$29.81	$53.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.57 / $3.91 / $15.05	Professional	26	$2.57	$3.91	$15.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $9.30 / $9.44 / $15.91	Professional	52	$9.30	$9.44	$15.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.80 / $25.01 / $39.14	Professional	TC	$15.80	$25.01	$39.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $19.55 / $24.85 / $27.72	Professional		$19.55	$24.85	$27.72
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.11 / $46.84 / $83.37	Professional		$24.11	$46.84	$83.37
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $3.28 / $10.52 / $19.12	Professional	26	$3.28	$10.52	$19.12
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $36.15 / $71.65 / $125.28	Professional	50	$36.15	$71.65	$125.28
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $35.42 / $64.34	Professional	TC	$20.96	$35.42	$64.34
CareSource Facility/Professional Facility Modifier Low / Median / High Price $3.12 / $20.42 / $29.24	Facility		$3.12	$20.42	$29.24
CareSource Facility/Professional Professional Modifier Low / Median / High Price $3.12 / $20.56 / $30.63	Professional		$3.12	$20.56	$30.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $26.10 / $26.62	Facility		$26.10	$26.10	$26.62
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $4.00	Facility	26	$3.41	$3.41	$4.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $19.51 / $31.28 / $63.29	Professional		$19.51	$31.28	$63.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.75 / $4.55 / $13.05	Professional	26	$2.75	$4.55	$13.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.69 / $25.74 / $50.28	Professional	TC	$16.69	$25.74	$50.28
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $26.10 / $26.62 / $90.94	Facility		$26.10	$26.62	$90.94
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $3.41 / $3.41 / $4.00	Facility	26	$3.41	$3.41	$4.00
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $18.30 / $30.83 / $66.81	Professional		$18.30	$30.83	$66.81
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $2.79 / $4.40 / $12.40	Professional	26	$2.79	$4.40	$12.40
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $17.37 / $25.31 / $47.22	Professional	TC	$17.37	$25.31	$47.22
Molina Facility/Professional Professional Modifier Low / Median / High Price $26.07 / $35.45 / $50.72	Professional		$26.07	$35.45	$50.72
United Facility/Professional Professional Modifier Low / Median / High Price $17.62 / $29.44 / $56.71	Professional		$17.62	$29.44	$56.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $2.80 / $3.96 / $11.12	Professional	26	$2.80	$3.96	$11.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $15.34 / $22.00 / $42.78	Professional	TC	$15.34	$22.00	$42.78