Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $453.59 / $1,221.06 / $2,840.88	Facility		$453.59	$1,221.06	$2,840.88
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.34 / $93.26 / $219.41	Facility	26	$72.34	$93.26	$219.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.98 / $256.52 / $882.00	Professional		$195.98	$256.52	$882.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.89 / $77.45 / $242.00	Professional	26	$63.89	$77.45	$242.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.22 / $175.12 / $355.81	Professional	TC	$129.22	$175.12	$355.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $140.55 / $144.55 / $202.04	Professional		$140.55	$144.55	$202.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $51.11 / $65.16 / $89.45	Professional	26	$51.11	$65.16	$89.45
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $216.09 / $285.32 / $511.79	Professional		$216.09	$285.32	$511.79
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.48 / $87.72 / $157.30	Professional	26	$67.48	$87.72	$157.30
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.74 / $196.66 / $350.36	Professional	TC	$138.74	$196.66	$350.36
CareSource Facility/Professional Facility Modifier Low / Median / High Price $69.80 / $134.16 / $237.18	Facility		$69.80	$134.16	$237.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $70.28 / $145.34 / $240.70	Professional		$70.28	$145.34	$240.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.50 / $289.88 / $465.96	Professional		$192.50	$289.88	$465.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.08 / $93.84 / $144.78	Professional	26	$67.08	$93.84	$144.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.98 / $193.90 / $325.17	Professional	TC	$122.98	$193.90	$325.17
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $845.36 / $1,511.93 / $2,829.82	Facility		$845.36	$1,511.93	$2,829.82
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $134.10 / $268.18 / $423.09	Professional		$134.10	$268.18	$423.09
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $69.16 / $93.15 / $144.78	Professional	26	$69.16	$93.15	$144.78
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $122.98 / $184.47 / $311.32	Professional	TC	$122.98	$184.47	$311.32
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.69 / $134.52 / $217.81	Professional		$64.69	$134.52	$217.81
United Facility/Professional Professional Modifier Low / Median / High Price $182.57 / $264.36 / $430.06	Professional		$182.57	$264.36	$430.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.61 / $88.48 / $145.74	Professional	26	$63.61	$88.48	$145.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.75 / $175.91 / $272.83	Professional	TC	$120.75	$175.91	$272.83