Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $186.21 / $295.12	Facility	26	$138.04	$186.21	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $776.25 / $1,380.38	Professional		$575.44	$776.25	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $199.53 / $389.05	Professional	26	$117.49	$199.53	$389.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $194.98 / $257.04 / $1,258.93	Professional	52	$194.98	$257.04	$1,258.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $616.60 / $1,096.48	Professional	TC	$467.74	$616.60	$1,096.48
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $616.60 / $933.25	Professional		$537.03	$616.60	$933.25
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $131.83 / $218.78	Professional	26	$112.20	$131.83	$218.78
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $524.81 / $575.44	Professional	TC	$457.09	$524.81	$575.44
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $831.76 / $1,380.38	Professional		$616.60	$831.76	$1,380.38
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $154.88 / $257.04	Professional	26	$109.65	$154.88	$257.04
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $501.19 / $691.83 / $1,122.02	Professional	TC	$501.19	$691.83	$1,122.02
Aultcare Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $660.69	Professional		$660.69	$660.69	$660.69
Aultcare Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $120.23 / $120.23	Professional	26	$120.23	$120.23	$120.23
Aultcare Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $537.03 / $537.03	Professional	TC	$537.03	$537.03	$537.03
CareSource Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $575.44 / $851.14	Professional		$134.90	$575.44	$851.14
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $891.25 / $1,659.59	Professional		$588.84	$891.25	$1,659.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $173.78 / $316.23	Professional	26	$114.82	$173.78	$316.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $707.95 / $1,318.26	Professional	TC	$478.63	$707.95	$1,318.26
Medical Mutual of Ohio Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $138.04 / $199.53	Facility	26	$29.51	$138.04	$199.53
Medical Mutual of Ohio Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $851.14 / $1,479.11	Professional		$489.78	$851.14	$1,479.11
Medical Mutual of Ohio Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $165.96 / $316.23	Professional	26	$104.71	$165.96	$316.23
Medical Mutual of Ohio Facility/Professional Professional Modifier 52 Low / Median / High Price $173.78 / $173.78 / $173.78	Professional	52	$173.78	$173.78	$173.78
Medical Mutual of Ohio Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $691.83 / $1,288.25	Professional	TC	$457.09	$691.83	$1,288.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $346.74	Professional		$32.36	$33.11	$346.74
SummaCare Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $1,047.13	Facility	26	$100.00	$100.00	$1,047.13
SummaCare Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $794.33 / $1,513.56	Professional		$691.83	$794.33	$1,513.56
SummaCare Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $154.88 / $281.84	Professional	26	$125.89	$154.88	$281.84
SummaCare Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $645.65 / $1,230.27	Professional	TC	$562.34	$645.65	$1,230.27
United Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $776.25 / $1,318.26	Professional		$549.54	$776.25	$1,318.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $158.49 / $269.15	Professional	26	$107.15	$158.49	$269.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $446.68 / $616.60 / $1,047.13	Professional	TC	$446.68	$616.60	$1,047.13