Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $426.58 / $831.76	Facility		$109.65	$426.58	$831.76
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $32.36 / $74.13	Facility	26	$24.55	$32.36	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $144.54 / $309.03	Professional		$104.71	$144.54	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.20 / $77.62	Professional	26	$20.89	$30.20	$77.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $104.71 / $173.78	Professional	TC	$85.11	$104.71	$173.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $112.20 / $199.53	Professional		$69.18	$112.20	$199.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $40.74	Professional	26	$21.88	$29.51	$40.74
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $141.25 / $229.09	Professional		$107.15	$141.25	$229.09
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $27.54 / $44.67	Professional	26	$21.38	$27.54	$44.67
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $112.20 / $181.97	Professional	TC	$83.18	$112.20	$181.97
CareSource Facility/Professional Facility Modifier Low / Median / High Price $22.39 / $91.20 / $120.23	Facility		$22.39	$91.20	$120.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $91.20 / $407.38	Facility		$91.20	$91.20	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $158.49 / $269.15	Professional		$109.65	$158.49	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $45.71	Professional	26	$21.88	$29.51	$45.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $128.82 / $229.09	Professional	TC	$87.10	$128.82	$229.09
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $239.88 / $407.38	Facility		$169.82	$239.88	$407.38
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $151.36 / $263.03	Professional		$107.15	$151.36	$263.03
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $29.51 / $44.67	Professional	26	$21.88	$29.51	$44.67
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $125.89 / $223.87	Professional	TC	$87.10	$125.89	$223.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $32.36 / $81.28	Professional		$20.42	$32.36	$81.28
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $128.82 / $128.82	Facility		$128.82	$128.82	$128.82
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $128.82 / $128.82	Facility	26	$128.82	$128.82	$128.82
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $141.25 / $251.19	Professional		$114.82	$141.25	$251.19
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $29.51 / $52.48	Professional	26	$23.99	$29.51	$52.48
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $112.20 / $199.53	Professional	TC	$89.13	$112.20	$199.53
United Facility/Professional Facility Modifier Low / Median / High Price $23.99 / $125.89 / $302.00	Facility		$23.99	$125.89	$302.00
United Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $141.25 / $245.47	Professional		$102.33	$141.25	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $26.30 / $50.12	Professional	26	$19.95	$26.30	$50.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $114.82 / $204.17	Professional	TC	$79.43	$114.82	$204.17