Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $478.63 / $1,949.84	Facility		$147.91	$478.63	$1,949.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $51.29 / $125.89	Facility	26	$44.67	$51.29	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $190.55 / $363.08	Professional		$141.25	$190.55	$363.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $56.23 / $112.20	Professional	26	$38.02	$56.23	$112.20
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $91.20 / $190.55 / $239.88	Professional	52	$91.20	$190.55	$239.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $134.90 / $251.19	Professional	TC	$102.33	$134.90	$251.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $117.49 / $169.82	Professional		$109.65	$117.49	$169.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $38.90 / $52.48	Professional	26	$34.67	$38.90	$52.48
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $27.54 / $33.88 / $57.54	Professional	52	$27.54	$33.88	$57.54
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $97.72 / $162.18	Professional	TC	$87.10	$97.72	$162.18
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $380.19 / $380.19 / $380.19	Facility		$380.19	$380.19	$380.19
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $199.53 / $316.23	Professional		$144.54	$199.53	$316.23
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $58.88 / $102.33	Professional	26	$41.69	$58.88	$102.33
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $138.04 / $229.09	Professional	TC	$100.00	$138.04	$229.09
CareSource Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $97.72 / $162.18	Facility		$39.81	$97.72	$162.18
CareSource Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $100.00 / $162.18	Professional		$42.66	$100.00	$162.18
Cigna Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $218.78 / $302.00	Facility		$208.93	$218.78	$302.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $43.65 / $63.10	Facility	26	$9.55	$43.65	$63.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $208.93 / $389.05	Professional		$128.82	$208.93	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $60.26 / $112.20	Professional	26	$38.02	$60.26	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $147.91 / $269.15	Professional	TC	$91.20	$147.91	$269.15
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $478.63 / $812.83	Facility		$251.19	$478.63	$812.83
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $9.55 / $43.65 / $63.10	Facility	26	$9.55	$43.65	$63.10
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $199.53 / $389.05	Professional		$125.89	$199.53	$389.05
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $56.23 / $107.15	Professional	26	$35.48	$56.23	$107.15
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $144.54 / $275.42	Professional	TC	$91.20	$144.54	$275.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $41.69	Professional		$32.36	$33.11	$41.69
SummaCare Facility/Professional Facility Modifier Low / Median / High Price $263.03 / $263.03 / $263.03	Facility		$263.03	$263.03	$263.03
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $263.03 / $263.03	Facility	26	$263.03	$263.03	$263.03
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $162.18 / $309.03	Professional		$134.90	$162.18	$309.03
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $47.86 / $89.13	Professional	26	$39.81	$47.86	$89.13
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $114.82 / $218.78	Professional	TC	$93.33	$114.82	$218.78
United Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $436.52 / $512.86	Facility		$436.52	$436.52	$512.86
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $199.53 / $338.84	Professional		$138.04	$199.53	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $54.95 / $95.50	Professional	26	$37.15	$54.95	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $144.54 / $239.88	Professional	TC	$97.72	$144.54	$239.88