Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $102.33 / $208.93	Facility	26	$70.79	$102.33	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $173.78 / $363.08	Professional		$141.25	$173.78	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $87.10 / $295.12	Professional	26	$63.10	$87.10	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $147.91 / $199.53	Professional		$138.04	$147.91	$199.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $75.86 / $87.10	Professional	26	$72.44	$75.86	$87.10
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $186.21 / $302.00	Professional		$147.91	$186.21	$302.00
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $123.03	Professional	26	$58.88	$77.62	$123.03
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $316.23 / $316.23	Professional		$316.23	$316.23	$316.23
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	26	$134.90	$134.90	$134.90
CareSource Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $69.18 / $79.43	Professional		$69.18	$69.18	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $109.65	Facility	26	$16.22	$75.86	$109.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $204.17 / $354.81	Professional		$147.91	$204.17	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $91.20 / $151.36	Professional	26	$66.07	$91.20	$151.36
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $16.22 / $75.86 / $109.65	Facility	26	$16.22	$75.86	$109.65
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $199.53 / $323.59	Professional		$141.25	$199.53	$323.59
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $89.13 / $141.25	Professional	26	$64.57	$89.13	$141.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $44.67	Professional		$32.36	$33.11	$44.67
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $194.98 / $363.08	Professional		$162.18	$194.98	$363.08
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $83.18 / $154.88	Professional	26	$69.18	$83.18	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $165.96 / $281.84	Professional		$123.03	$165.96	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $74.13 / $125.89	Professional	26	$54.95	$74.13	$125.89