Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $145.04 / $575.78 / $1,005.00	Facility		$145.04	$575.78	$1,005.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.98 / $31.46 / $66.73	Facility	26	$20.98	$31.46	$66.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.27 / $168.37 / $334.93	Professional		$120.27	$168.37	$334.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $25.59 / $58.85	Professional	26	$20.98	$25.59	$58.85
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.50 / $62.47 / $108.29	Professional	52	$59.50	$62.47	$108.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.28 / $140.37 / $263.32	Professional	TC	$99.28	$140.37	$263.32
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.99 / $102.08 / $242.67	Professional		$92.99	$102.08	$242.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.05 / $19.72 / $33.25	Professional	26	$16.05	$19.72	$33.25
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.29 / $176.94 / $317.13	Professional		$138.29	$176.94	$317.13
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.79 / $26.07 / $45.33	Professional	26	$19.79	$26.07	$45.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $112.17 / $153.66 / $272.70	Professional	TC	$112.17	$153.66	$272.70
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.95 / $112.23 / $156.91	Facility		$21.95	$112.23	$156.91
CareSource Facility/Professional Professional Modifier Low / Median / High Price $22.07 / $116.02 / $164.39	Professional		$22.07	$116.02	$164.39
Cigna Facility/Professional Facility Modifier Low / Median / High Price $209.45 / $301.77 / $638.50	Facility		$209.45	$301.77	$638.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.17 / $176.80 / $290.39	Professional		$119.17	$176.80	$290.39
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.66 / $29.05 / $43.18	Professional	26	$20.66	$29.05	$43.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $99.20 / $150.28 / $246.52	Professional	TC	$99.20	$150.28	$246.52
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $280.55 / $389.16 / $822.51	Facility		$280.55	$389.16	$822.51
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $117.12 / $168.38 / $282.37	Professional		$117.12	$168.38	$282.37
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $21.06 / $29.52 / $43.01	Professional	26	$21.06	$29.52	$43.01
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $99.20 / $147.05 / $246.52	Professional	TC	$99.20	$147.05	$246.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $77.94 / $106.74 / $150.62	Professional		$77.94	$106.74	$150.62
United Facility/Professional Professional Modifier Low / Median / High Price $112.57 / $162.36 / $284.25	Professional		$112.57	$162.36	$284.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.32 / $28.01 / $53.72	Professional	26	$19.32	$28.01	$53.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.40 / $141.22 / $245.74	Professional	TC	$95.40	$141.22	$245.74