Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $776.25 / $1,122.02	Facility		$213.80	$776.25	$1,122.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $50.12 / $72.44	Facility	26	$40.74	$50.12	$72.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $489.78	Professional		$165.96	$234.42	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $50.12 / $117.49	Professional	26	$34.67	$50.12	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $169.82 / $323.59	Professional	TC	$128.82	$169.82	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $169.82 / $229.09	Professional		$134.90	$169.82	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $37.15 / $51.29	Professional	26	$30.90	$37.15	$51.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $186.21	Professional	TC	$109.65	$109.65	$186.21
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $218.78 / $354.81	Professional		$154.88	$218.78	$354.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $41.69 / $69.18	Professional	26	$32.36	$41.69	$69.18
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $173.78 / $281.84	Professional	TC	$125.89	$173.78	$281.84
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Professional		$162.18	$162.18	$162.18
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	26	$36.31	$36.31	$36.31
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $125.89 / $125.89	Professional	TC	$125.89	$125.89	$125.89
CareSource Facility/Professional Facility Modifier Low / Median / High Price $40.74 / $154.88 / $263.03	Facility		$40.74	$154.88	$263.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $151.36 / $223.87	Professional		$38.90	$151.36	$223.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $138.04 / $138.04 / $831.76	Facility		$138.04	$138.04	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $234.42 / $398.11	Professional		$169.82	$234.42	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $46.77 / $72.44	Professional	26	$33.11	$46.77	$72.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $346.74	Professional	TC	$131.83	$194.98	$346.74
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $616.60 / $1,023.29	Facility		$457.09	$616.60	$1,023.29
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $229.09 / $380.19	Professional		$162.18	$229.09	$380.19
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $45.71 / $72.44	Professional	26	$32.36	$45.71	$72.44
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $186.21 / $331.13	Professional	TC	$128.82	$186.21	$331.13
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 Professional Modifier Low / Median / High Price $173.78 / $218.78 / $389.05	Professional		$173.78	$218.78	$389.05
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $47.86 / $85.11	Professional	26	$38.90	$47.86	$85.11
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $169.82 / $302.00	Professional	TC	$138.04	$169.82	$302.00
United Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $173.78 / $676.08	Facility		$34.67	$173.78	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $213.80 / $380.19	Professional		$154.88	$213.80	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $40.74 / $81.28	Professional	26	$30.20	$40.74	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $173.78 / $302.00	Professional	TC	$120.23	$173.78	$302.00