Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $912.01 / $1,513.56	Facility		$218.78	$912.01	$1,513.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $42.66 / $61.66	Facility	26	$31.62	$42.66	$61.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $141.25 / $194.98 / $562.34	Facility	TC	$141.25	$194.98	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $257.04 / $741.31	Professional		$169.82	$257.04	$741.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $43.65 / $123.03	Professional	26	$30.20	$43.65	$123.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $190.55 / $426.58	Professional	TC	$141.25	$190.55	$426.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $144.54 / $208.93	Professional		$131.83	$144.54	$208.93
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $31.62 / $50.12	Professional	26	$25.12	$31.62	$50.12
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $190.55 / $194.98	Professional	TC	$117.49	$190.55	$194.98
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $223.87 / $363.08	Professional		$169.82	$223.87	$363.08
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $42.66 / $69.18	Professional	26	$31.62	$42.66	$69.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $177.83 / $288.40	Professional	TC	$138.04	$177.83	$288.40
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $177.83 / $346.74	Professional		$165.96	$177.83	$346.74
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $33.11 / $63.10	Professional	26	$30.20	$33.11	$63.10
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $144.54 / $281.84	Professional	TC	$134.90	$144.54	$281.84
CareSource Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $165.96 / $269.15	Facility		$34.67	$165.96	$269.15
CareSource Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $158.49 / $239.88	Professional		$33.11	$158.49	$239.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $234.42 / $588.84	Facility		$147.91	$234.42	$588.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $245.47 / $426.58	Professional		$173.78	$245.47	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $43.65 / $67.61	Professional	26	$31.62	$43.65	$67.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $208.93 / $363.08	Professional	TC	$141.25	$208.93	$363.08
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $758.58 / $1,258.93	Facility		$436.52	$758.58	$1,258.93
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $229.09 / $398.11	Professional		$147.91	$229.09	$398.11
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $43.65 / $70.79	Professional	26	$30.90	$43.65	$70.79
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $199.53 / $346.74	Professional	TC	$138.04	$199.53	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $131.83	Professional		$32.36	$33.11	$131.83
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 $177.83 / $223.87 / $398.11	Professional		$177.83	$223.87	$398.11
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $41.69 / $72.44	Professional	26	$33.11	$41.69	$72.44
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $181.97 / $323.59	Professional	TC	$144.54	$181.97	$323.59
United Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $190.55 / $676.08	Facility		$36.31	$190.55	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $223.87 / $398.11	Professional		$162.18	$223.87	$398.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $38.02 / $70.79	Professional	26	$28.18	$38.02	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $186.21 / $323.59	Professional	TC	$134.90	$186.21	$323.59