Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.21 / $481.39 / $1,105.00	Facility		$149.21	$481.39	$1,105.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.62 / $50.42 / $126.57	Facility	26	$44.62	$50.42	$126.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $143.05 / $174.29 / $341.95	Professional		$143.05	$174.29	$341.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.86 / $47.94 / $98.76	Professional	26	$38.86	$47.94	$98.76
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $189.11 / $189.11 / $189.11	Professional	52	$189.11	$189.11	$189.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $99.69 / $122.52 / $198.38	Professional	TC	$99.69	$122.52	$198.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $105.12 / $107.97 / $162.53	Professional		$105.12	$107.97	$162.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $33.50 / $40.10 / $56.50	Professional	26	$33.50	$40.10	$56.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $101.10 / $101.10 / $101.10	Professional	TC	$101.10	$101.10	$101.10
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $367.00 / $367.00 / $371.00	Facility		$367.00	$367.00	$371.00
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.05 / $188.52 / $299.97	Professional		$144.05	$188.52	$299.97
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.60 / $56.29 / $100.86	Professional	26	$41.60	$56.29	$100.86
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $92.47 / $122.94 / $213.90	Professional	TC	$92.47	$122.94	$213.90
CareSource Facility/Professional Facility Modifier Low / Median / High Price $38.27 / $94.77 / $156.72	Facility		$38.27	$94.77	$156.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $43.22 / $103.53 / $158.56	Professional		$43.22	$103.53	$158.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $250.00 / $250.00	Facility		$250.00	$250.00	$250.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.88 / $210.98 / $396.14	Professional		$125.88	$210.98	$396.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.52 / $60.15 / $116.09	Professional	26	$37.52	$60.15	$116.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.59 / $151.32 / $290.99	Professional	TC	$91.59	$151.32	$290.99
Medical Mutual of Ohio Facility/Professional Facility Modifier Low / Median / High Price $250.00 / $469.55 / $810.05	Facility		$250.00	$469.55	$810.05
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $125.88 / $191.56 / $353.92	Professional		$125.88	$191.56	$353.92
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $37.38 / $56.50 / $104.45	Professional	26	$37.38	$56.50	$104.45
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $91.59 / $131.41 / $251.69	Professional	TC	$91.59	$131.41	$251.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $39.24 / $112.04 / $171.52	Professional		$39.24	$112.04	$171.52
United Facility/Professional Professional Modifier Low / Median / High Price $143.57 / $209.36 / $340.25	Professional		$143.57	$209.36	$340.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.33 / $60.91 / $100.22	Professional	26	$38.33	$60.91	$100.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.36 / $155.53 / $243.73	Professional	TC	$107.36	$155.53	$243.73