Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $891.25 / $1,348.96	Facility		$234.42	$891.25	$1,348.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $48.98 / $69.18	Facility	26	$36.31	$48.98	$69.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $186.21 / $257.04 / $602.56	Facility	TC	$186.21	$257.04	$602.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $616.60	Professional		$190.55	$281.84	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $48.98 / $104.71	Professional	26	$32.36	$48.98	$104.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $457.09	Professional	TC	$169.82	$229.09	$457.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $186.21 / $218.78	Professional		$162.18	$186.21	$218.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $31.62 / $50.12	Professional	26	$28.84	$31.62	$50.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $151.36 / $162.18	Professional	TC	$144.54	$151.36	$162.18
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $223.87 / $380.19	Professional		$173.78	$223.87	$380.19
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $37.15 / $61.66	Professional	26	$28.84	$37.15	$61.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $186.21 / $316.23	Professional	TC	$144.54	$186.21	$316.23
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $208.93 / $346.74	Facility		$39.81	$208.93	$346.74
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $204.17 / $302.00	Professional		$38.02	$204.17	$302.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $263.03 / $724.44	Facility		$194.98	$263.03	$724.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $309.03 / $524.81	Professional		$208.93	$309.03	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $43.65 / $72.44	Professional	26	$30.20	$43.65	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.97 / $269.15 / $478.63	Professional	TC	$181.97	$269.15	$478.63
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $630.96 / $1,412.54	Facility		$436.52	$630.96	$1,412.54
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $489.78	Professional		$208.93	$295.12	$489.78
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $43.65 / $72.44	Professional	26	$29.51	$43.65	$72.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $257.04 / $446.68	Professional	TC	$177.83	$257.04	$446.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $33.11 / $117.49	Professional		$29.51	$33.11	$117.49
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Facility		$295.12	$295.12	$295.12
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
SummaCare Facility/Professional Facility Modifier TC Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	TC	$295.12	$295.12	$295.12
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $288.40 / $512.86	Professional		$229.09	$288.40	$512.86
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $46.77 / $83.18	Professional	26	$38.02	$46.77	$83.18
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $239.88 / $426.58	Professional	TC	$190.55	$239.88	$426.58
United Facility/Professional Facility Modifier Low / Median / High Price $30.90 / $218.78 / $676.08	Facility		$30.90	$218.78	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $281.84 / $512.86	Professional		$208.93	$281.84	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $39.81 / $79.43	Professional	26	$27.54	$39.81	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $245.47 / $426.58	Professional	TC	$173.78	$245.47	$426.58