Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.09 / $519.82 / $1,065.56	Facility		$99.09	$519.82	$1,065.56
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.26 / $30.24 / $67.63	Facility	26	$20.26	$30.24	$67.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $120.56 / $481.28 / $1,049.04	Facility	TC	$120.56	$481.28	$1,049.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.22 / $124.27 / $328.30	Professional		$28.22	$124.27	$328.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.26 / $27.35 / $77.92	Professional	26	$20.26	$27.35	$77.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.54 / $109.42 / $176.39	Professional	TC	$89.54	$109.42	$176.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.89 / $89.94 / $164.01	Professional		$80.89	$89.94	$164.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $15.36 / $19.41 / $32.63	Professional	26	$15.36	$19.41	$32.63
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $71.40 / $73.20 / $133.49	Professional	TC	$71.40	$73.20	$133.49
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $99.94 / $131.31 / $234.63	Professional		$99.94	$131.31	$234.63
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $20.09 / $25.78 / $45.89	Professional	26	$20.09	$25.78	$45.89
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $79.84 / $104.89 / $182.58	Professional	TC	$79.84	$104.89	$182.58
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $105.81 / $105.81 / $137.55	Professional		$105.81	$105.81	$137.55
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $19.68 / $19.68 / $25.58	Professional	26	$19.68	$19.68	$25.58
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $86.12 / $86.12 / $111.96	Professional	TC	$86.12	$86.12	$111.96
CareSource Facility/Professional Facility Modifier Low / Median / High Price $21.45 / $101.62 / $142.84	Facility		$21.45	$101.62	$142.84
CareSource Facility/Professional Professional Modifier Low / Median / High Price $21.65 / $104.16 / $148.13	Professional		$21.65	$104.16	$148.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $171.20 / $264.33 / $528.41	Facility		$171.20	$264.33	$528.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.10 / $160.86 / $272.02	Professional		$111.10	$160.86	$272.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.60 / $28.41 / $42.90	Professional	26	$20.60	$28.41	$42.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.59 / $133.36 / $230.95	Professional	TC	$89.59	$133.36	$230.95
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $224.24 / $520.48 / $1,044.90	Facility		$224.24	$520.48	$1,044.90
Medical Mutual of Ohio Facility/Professional Facility Modifier TC Low / Median / High Price $705.52 / $705.52 / $1,092.89	Facility	TC	$705.52	$705.52	$1,092.89
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $97.89 / $155.22 / $265.44	Professional		$97.89	$155.22	$265.44
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $20.85 / $29.78 / $52.78	Professional	26	$20.85	$29.78	$52.78
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $89.59 / $129.78 / $225.07	Professional	TC	$89.59	$129.78	$225.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $77.94 / $106.37 / $150.62	Professional		$77.94	$106.37	$150.62
United Facility/Professional Professional Modifier Low / Median / High Price $103.04 / $148.22 / $254.88	Professional		$103.04	$148.22	$254.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.32 / $27.35 / $51.04	Professional	26	$19.32	$27.35	$51.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.41 / $123.63 / $226.83	Professional	TC	$85.41	$123.63	$226.83