Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $119.47 / $432.42 / $1,132.25	Facility		$119.47	$432.42	$1,132.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.31 / $31.96 / $73.14	Facility	26	$22.31	$31.96	$73.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.91 / $142.21 / $381.61	Professional		$118.91	$142.21	$381.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.60 / $24.54 / $66.70	Professional	26	$19.60	$24.54	$66.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.16 / $116.35 / $189.87	Professional	TC	$97.16	$116.35	$189.87
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $90.73 / $105.11 / $134.16	Professional		$90.73	$105.11	$134.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $16.54 / $24.81 / $35.36	Professional	26	$16.54	$24.81	$35.36
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.54 / $134.03 / $231.00	Professional		$97.54	$134.03	$231.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $17.69 / $24.31 / $41.24	Professional	26	$17.69	$24.31	$41.24
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.84 / $109.90 / $187.45	Professional	TC	$79.84	$109.90	$187.45
CareSource Facility/Professional Facility Modifier Low / Median / High Price $23.26 / $122.63 / $171.38	Facility		$23.26	$122.63	$171.38
CareSource Facility/Professional Professional Modifier Low / Median / High Price $23.47 / $126.95 / $180.44	Professional		$23.47	$126.95	$180.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $208.06 / $264.33 / $528.41	Facility		$208.06	$264.33	$528.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.33 / $189.10 / $326.76	Professional		$131.33	$189.10	$326.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.88 / $28.87 / $44.88	Professional	26	$20.88	$28.87	$44.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.89 / $162.44 / $280.29	Professional	TC	$110.89	$162.44	$280.29
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $208.17 / $281.67 / $654.95	Facility		$208.17	$281.67	$654.95
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $126.95 / $184.08 / $291.99	Professional		$126.95	$184.08	$291.99
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $21.34 / $29.23 / $44.88	Professional	26	$21.34	$29.23	$44.88
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $110.89 / $160.27 / $265.69	Professional	TC	$110.89	$160.27	$265.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $40.43 / $115.47 / $179.83	Professional		$40.43	$115.47	$179.83
United Facility/Professional Professional Modifier Low / Median / High Price $125.11 / $183.04 / $319.81	Professional		$125.11	$183.04	$319.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.18 / $28.81 / $52.07	Professional	26	$19.18	$28.81	$52.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.72 / $153.74 / $273.48	Professional	TC	$106.72	$153.74	$273.48